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Pocobello R, Camilli F, Alvarez-Monjaras M, Bergström T, von Peter S, Hopfenbeck M, Aderhold V, Pilling S, Seikkula J, el Sehity TJ. Open Dialogue services around the world: a scoping survey exploring organizational characteristics in the implementation of the Open Dialogue approach in mental health services. Front Psychol 2023; 14:1241936. [PMID: 38023059 PMCID: PMC10668593 DOI: 10.3389/fpsyg.2023.1241936] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally. Methods A structured questionnaire including a self-assessment scale to measure teams' adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD self-assessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation. Results The survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD teams comprised professionals from diverse backgrounds with varying levels of OD training. Factors positively associated with OD self-assessment included a high percentage of staff with OD training, periodic supervisions, research capacity, multi-professional teams, self-referrals, outpatient services, younger client groups, and the involvement of experts by experience in periodic supervision. Conclusion The findings provide valuable insights into the characteristics and practices of OD teams globally, highlighting the need for increased training opportunities, supervision, and research engagement. Future research should follow the development of OD implementation over time, complement self-assessment with rigorous observations and external evaluations, focus on involving different stakeholders in the OD-self-assessment and investigate the long-term outcomes of OD in different contexts.
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Affiliation(s)
| | | | - Mauricio Alvarez-Monjaras
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
- Department of Psychiatry, Länsi-Pohja Hospital District, Kemi, Finland
| | - Sebastian von Peter
- Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Mark Hopfenbeck
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Stephen Pilling
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
- Department of Psychology, University of Agder: Kristiansand, Kristiansand, Norway
| | - Tarek Josef el Sehity
- Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy
- Faculty of Psychology, Sigmund Freud Private University, Vienna, Austria
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Heumann K, Kuhlmann M, Böning M, Tülsner H, Pocobello R, Ignatyev Y, Aderhold V, von Peter S. Implementation of open dialogue in Germany: Efforts, challenges, and obstacles. Front Psychol 2023; 13:1072719. [PMID: 36846479 PMCID: PMC9948650 DOI: 10.3389/fpsyg.2022.1072719] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/20/2022] [Indexed: 02/11/2023] Open
Abstract
Purpose The Open Dialogue (OD) approach has been implemented in different countries worldwide. OD not only depends on therapeutic principles but also requires a distinct set of structural changes that may impede its full implementation. In Germany, OD is currently practiced in different mental health care settings across the country. Yet, full implementation of OD principles is limited due to the extreme structural and financial fragmentation of the German mental health care system. With this as a background, the aim of this study was to investigate the efforts, challenges and obstacles of OD implementation in Germany. Methods This article presents the German results from the international HOPEnDIALOGUE survey, supplemented with expert interview data. Thirty eight teams currently providing OD took part in the survey. Sixteen expert interviews were carried out with stakeholders from various care settings. Survey data were analyzed descriptively and the qualitative data were evaluated using a thematic analysis approach. Results While having to adapt to the fragmented German health care system, OD has been mainly implemented from outpatient service providers and stand-alone services. About half of the teams implemented OD under the conditions of cross-sectoral model contracts and, thus, are considerably limited when it comes to OD implementation. Altogether, OD is not implemented to its full extent in each of the institutions surveyed. Similarly, the expert interviews revealed various challenges that mainly relate to the realization of OD's structural principles, whereas the implementation of its therapeutic benefits remains less affected. However, these challenges have managed to lead to great commitment by single teams and a certain level of implementation of OD-related concepts. Conclusion OD in Germany can currently only be fully implemented under the cross-sectoral care model contract system that is often temporary, thus significantly hindering its continuous development. Any evaluation of OD's effectiveness in Germany thus needs to take into account the fragmented nature of the country's health care system and control for the multiple barriers that impede implementation. Reforms of the German health care system are also urgently needed to create more favorable conditions for the implementation of OD.
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Affiliation(s)
- Kolja Heumann
- Integrated Working Group “Mental Health”, Brandenburg Medical School, Brandenburg an der Havel, Germany,*Correspondence: Kolja Heumann, ✉
| | - Mira Kuhlmann
- Integrated Working Group “Mental Health”, Brandenburg Medical School, Brandenburg an der Havel, Germany
| | - Maike Böning
- Department of Psychology, University of Marburg, Marburg, Germany
| | - Helene Tülsner
- Department of Social Work, Alice Salomon University, Berlin, Germany
| | - Raffaella Pocobello
- National Research Council of Italy, Institute of Cognitive Sciences and Technologies, Rome, Italy
| | - Yuriy Ignatyev
- Department of Psychiatry and Psychotherapy, Immanuel Hospital Rüdersdorf, Brandenburg Medical School, Rüdersdorf, Germany
| | - Volkmar Aderhold
- Department of Psychiatry, Charité University Medicine, Berlin, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Immanuel Hospital Rüdersdorf, Brandenburg Medical School, Rüdersdorf, Germany
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von Peter S, Bergstrøm T, Nenoff-Herchenbach I, Hopfenbeck MS, Pocobello R, Aderhold V, Alvarez-Monjaras M, Seikkula J, Heumann K. Dialogue as a Response to the Psychiatrization of Society? Potentials of the Open Dialogue Approach. Front Sociol 2021; 6:806437. [PMID: 35004940 PMCID: PMC8727686 DOI: 10.3389/fsoc.2021.806437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/07/2021] [Indexed: 06/01/2023]
Abstract
In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide. A recent article proposed the concept of psychiatrization as an explanatory framework, describing multiple processes responsible for the spread of psychiatric concepts and forms of treatment. This article aims to explore the potentials of the Open Dialogue (OD) approach for engaging in less psychiatrizing forms of psychosocial support. While OD may not be an all-encompassing solution to de-psychiatrization, this paper refers to previous research showing that OD has the potential to 1) limit the use of neuroleptics, 2), reduce the incidences of mental health problems and 3) decrease the use of psychiatric services. It substantiates these potentials to de-psychiatrize psychosocial support by exploring the OD's internal logic, its use of language, its processes of meaning-making, its notion of professionalism, its promotion of dialogue and how OD is set up structurally. The conclusion touches upon the dangers of co-optation, formalization and universalization of the OD approach and stresses the need for more societal, layperson competencies in dealing with psychosocial crises.
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Affiliation(s)
| | - Tomi Bergstrøm
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | | | - Mark Steven Hopfenbeck
- Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Raffaella Pocobello
- National Research Council of Italy, Institute of Cognitive Sciences and Technologies, Rome, Italy
| | - Volkmar Aderhold
- Department of Psychiatry, Charité University Medicine, Berlin, Germany
| | - Mauricio Alvarez-Monjaras
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jaakko Seikkula
- Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
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von Peter S, Aderhold V, Cubellis L, Bergström T, Stastny P, Seikkula J, Puras D. Open Dialogue as a Human Rights-Aligned Approach. Front Psychiatry 2019; 10:387. [PMID: 31214063 PMCID: PMC6555154 DOI: 10.3389/fpsyt.2019.00387] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/16/2019] [Indexed: 11/16/2022] Open
Abstract
Throughout the last 20 years, the human rights perspective has increasingly developed into a paradigm against which to appraise and evaluate mental health care. This article investigates to what extent the Finnish open dialogue (OD) approach both aligns with human rights and may be qualified to strengthen compliance with human rights perspectives in global mental health care. Being a conceptual paper, the structural and therapeutic principles of OD are theoretically discussed against the background of human rights, as framed by the Universal Declaration of Human Rights, the UN Convention on the Rights of People with Disabilities, and the two recent annual reports of the Human Rights Council. It is shown that OD aligns well with discourses on human rights, being a largely non-institutional and non-medicalizing approach that both depends on and fosters local and context-bound forms of knowledge and practice. Its fundamental network perspective facilitates a contextual and relational understanding of mental well-being, as postulated by contemporary human rights approaches. OD opens the space for anyone to speak (out), for mutual respect and equality, for autonomy, and to address power differentials, making it well suited to preventing coercion and other forms of human rights violation. It is concluded that OD can be understood as a human rights-aligned approach.
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Affiliation(s)
- Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg, Neuruppin, Germany
| | - Volkmar Aderhold
- Department of Psychiatry and Psychotherapy, Medical University Greifswald, Greifswald, Germany
| | - Lauren Cubellis
- Department of Anthropology, Washington University St. Louis, St. Louis, MO, United States
| | - Tomi Bergström
- Department of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | | | - Jaakko Seikkula
- Department of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Dainius Puras
- Department of Psychiatry and Psychology, Vilnius University, Vilnius, Lithuania
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Aderhold V. [How human rights can guide german psychiatry]. Fortschr Neurol Psychiatr 2018; 86:477-484. [PMID: 30125921 DOI: 10.1055/a-0646-4054] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The concerns and recommendations of the UN "Final Remarks" on the first German State Report are substantiated by up-to-date health reporting data. Their "recommendations" are substantiated by evidence-based care models and supplemented by additional content from the Special Rapporteur's report of 2017 as visions for German psychiatric care, thus demonstrating the path of psychiatry determined by respect for human rights and social inclusion. The avoidance of coercion through traumainformed treatment and the development of complex outpatient treatment structures through the models of open dialogue and the recovery approach are seen as the focus of a paradigm shift. The awareness that in today's psychiatry, especially through deficient structures, human rights violations are committed that could be avoided, should contribute to the determination for the necessary changes.
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Affiliation(s)
- Volkmar Aderhold
- Universitätsmedizin Greifswald, Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e. V.
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Zinkler M, Beine KH, von Cranach M, Osterfeld M, Kaiser M, Weinmann S, Aderhold V. [Compulsory treatment with electroconvulsive therapy-scientifically unproven and questionable therapy with respect to human rights]. Nervenarzt 2018; 89:837-838. [PMID: 29926127 DOI: 10.1007/s00115-018-0558-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Zinkler
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Universität Ulm, Kliniken Landkreis Heidenheim gGmbH, Schloßhaustraße 100, 89522, Heidenheim, Deutschland.
| | - K H Beine
- St. Marien-Hospital Hamm, Lehrstuhl für Psychiatrie und Psychotherapie, Universität Witten/Herdecke, Hamm, Deutschland
| | | | - M Osterfeld
- Unterausschuss zur Prävention von Folter und anderen grausamen unwürdigen oder erniedrigenden Behandlungen oder Strafen der Vereinten Nationen (UN SPT), Dortmund, Deutschland
| | - M Kaiser
- Klinik und Tagesklinik für Psychiatrie, Psychotherapie und Psychosomatik mit Psychiatrischer Institutsambulanz, Klinikum Merzig, Merzig, Deutschland
| | - S Weinmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin, Deutschland
| | - V Aderhold
- Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e. V, Greifswald, Deutschland
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Weinmann S, Aderhold V. [Pros and cons of antipsychotic drugs in Prodromal stages of schizophrenia]. Nervenarzt 2017; 88:1076-1078. [PMID: 28084500 DOI: 10.1007/s00115-016-0274-y] [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] [Indexed: 06/06/2023]
Affiliation(s)
- S Weinmann
- Zentrum für Psychotische Erkrankungen, Universitäre Psychiatrische Kliniken Basel, Wilhelm-Klein-Strasse 27, 4012, Basel, Schweiz.
| | - V Aderhold
- Institut für Sozialpsychiatrie, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Deutschland
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Schäfer I, Eiroa-Orosa FJ, Schroeder K, Harfst T, Aderhold V. [Posttraumatic disorders in patients with schizophrenia spectrum disorders]. Nervenarzt 2015; 86:818-25. [PMID: 26022856 DOI: 10.1007/s00115-014-4237-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The findings of international studies suggest high rates of interpersonal violence and posttraumatic stress disorder (PTSD) among patients with schizophrenia spectrum disorders. Only few studies, however, have so far been conducted in the German-speaking countries. OBJECTIVES The aim of our study was to determine the prevalence of lifetime experiences of interpersonal violence and comorbid PTSD among inpatients in a German university hospital. METHOD In N = 145 consecutively admitted patients with schizophrenia spectrum disorders (67 % male) the structured trauma interview (STI) was used to assess experiences of interpersonal violence and the structured clinical interview for DSM-IV (SCID) to assess comorbid PTSD. RESULTS Sexual violence under the age of 16 years was reported by 17 % of the patients (women 27 %, men 12 %). Approximately one third (32 %) reported physical violence by parental figures (women 38 %, men 29 %). At least one form of early violence (sexual or physical) was reported by half of the women (48 %) and one third of the men (34 %). Negative sexual experiences later in life were reported by 17 %, physical violence by 38 % and at least one of these forms by 48 % of the patients. In total two thirds of all patients (66 %) reported experiences of violence during their lifetime. The prevalence of acute PTSD was 12 %. Another 9 % of patients had a subsyndromal PTSD. CONCLUSION The present study confirmed the high rates of experiences of interpersonal violence and comorbid PTSD in a German sample of patients with schizophrenia spectrum disorders. Violence and it's consequences should therefore be routinely assessed and the full spectrum of trauma-specific therapies should be integrated into the treatment of this group of patients.
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Affiliation(s)
- I Schäfer
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland,
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Weinmann S, Aderhold V. Antipsychotic medication, mortality and neurodegeneration: The need for more selective use and lower doses. Psychosis 2010. [DOI: 10.1080/17522430903501999] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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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Weinmann S, Aderhold V, Müller-Oerlinghausen B. Influence of antipsychotics on mortality in schizophrenia: evidence from observational studies. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Kruckenberg P, Beine K, Aderhold V, Bock T, Bührig M, Deister A, Driessen M, Elsässer-Gaismaier HP, Grampp P, Greve N, Heinz A, Heinze M, Heisler M, Küthmann A, Kunze H, Lucht M, Niedermeyer U, Obliers W, Schütze W, Stock M. [Psychiatric psychotherapeutic psychosomatic treatment by the hospital: framework for the development of a multi-sector budget for regional mandatory care]. Psychiatr Prax 2009; 36:246-249. [PMID: 19582663 DOI: 10.1055/s-0029-1233425] [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] [Indexed: 05/28/2023]
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Aderhold V. [Response to the position of the "Biological Psychiatry" Working Group of the Federal Directors Conference--Association of Executive Physicians of Psychiatry and Psychotherapy Clinics (BDK) e.V]. Psychiatr Prax 2009; 36:94-95. [PMID: 19358097 DOI: 10.1055/s-0029-1220828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Schafer I, Reitemeier B, Langer L, Aderhold V, Harfst T. Dissociation in patients with schizophrenia: Relationships with childhood trauma and psychotic symptoms. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.882] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Reimer J, Aderhold V, Lambert M, Haasen C. Manifestation of multiple sclerosis with paranoidhallucinatory psychosis. J Neurol 2006; 253:531-2. [PMID: 16435081 DOI: 10.1007/s00415-005-0024-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 08/09/2005] [Accepted: 08/16/2005] [Indexed: 11/25/2022]
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Schäfer I, Harfst T, Aderhold V, Briken P, Lehmann M, Moritz S, Read J, Naber D. Childhood trauma and dissociation in female patients with schizophrenia spectrum disorders: an exploratory study. J Nerv Ment Dis 2006; 194:135-8. [PMID: 16477194 DOI: 10.1097/01.nmd.0000198199.57512.84] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [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: 11/26/2022]
Abstract
The few studies that have investigated the relationship between trauma and dissociative symptoms in patients with schizophrenia have not assessed the role of the severity of psychotic symptoms. The current study examined correlations among five domains of childhood trauma and dissociative symptoms in 30 female patients with schizophrenia spectrum disorders, using the Dissociative Experiences Scale and the Childhood Trauma Questionnaire. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale. Consistent with previous studies, high levels of childhood traumatic experiences were found (Childhood Trauma Questionnaire total score M = 48.5, SD = 18.3). Physical neglect and emotional abuse showed significant correlations with dissociative symptoms at admission. When patients were stabilized, about a month after admission, emotional abuse still showed a significant correlation with dissociative symptoms. However, in contrast to previous findings, Dissociative Experiences Scale findings were not stable over time. Our results confirm the relevance of childhood trauma in schizophrenic patients but also demonstrate the need to develop appropriate methodologies for measuring dissociation in this population.
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Affiliation(s)
- Ingo Schäfer
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany
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Abstract
In light of recent studies indicating a relationship between child abuse and the positive symptoms of schizophrenia, this study investigated the hypotheses that childhood sexual and physical abuse are related to hallucinations, delusions, and thought disorder in adults, and that those relationships are greater in those who have suffered abuse during adulthood as well as childhood. In 200 community mental-health-centre clients, the clinically evaluated symptomatology of the 92 clients whose files documented sexual or physical abuse at some point in their lives was compared with that of the 108 for whom no abuse was documented. In the 60 patients for whom child abuse was documented, hallucinations (including all six subtypes), but not delusions, thought disorder or negative symptoms, were significantly more common than in the non-abused group. Adult sexual assault was related to hallucinations, delusions, and thought disorder. In linear regression analysis, a combination of child abuse and adult abuse predicted hallucinations, delusions, and thought disorder. However, child abuse was a significant predictor of auditory and tactile hallucinations, even in the absence of adult abuse. Possible psychological and neurobiological pathways from abuse to symptoms are discussed, along with research and clinical implications.
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Affiliation(s)
- John Read
- Psychology Department, University of Auckland, New Zealand.
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