Increasing self-esteem: Efficacy of a group intervention for individuals with severe mental disorders

Background

Individuals with psychosis are known to have a lower self-esteem compared to the general population, in part because of social stigma, paternalistic care, long periods of institutionalization and negative family interactions. This study aimed at assessing the efficacy of a self-esteem enhancement program for individuals with severe mental illness and at analyzing the results in their European context.

Method

A randomized cross-over study including 54 outpatients with a diagnosis of schizophrenia from Geneva, Switzerland, was conducted. Twenty-four were recruited from an outpatient facility receiving traditional psychiatric care whereas 30 came from an outpatient facility with case-management care. Psychosocial, diagnostic and symptom measures were taken for all the subjects before treatment, after treatment, and at 3-months' follow-up.

Results

Results indicated significant positive self-esteem module effects on self-esteem, self-assertion, active coping strategies and symptom for the participants receiving case-management care. Results were not significant for those receiving traditional care. However, 71% of all participants expressed satisfaction with the module.

Conclusion

Individuals with schizophrenia appear to be benefit from the effects of the self-esteem module, particularly when they are involved in a rehabilitation program and followed by a case manager who liaises with the other partners of the multidisciplinary team. This encourages reconsidering the interventions' format and setting in order to ensure lasting effects on the environment and in turn on coping, self-esteem and overall empowerment.

Religious explanatory models in patients with psychosis: a three-year follow-up study

BACKGROUND/AIMS

Spirituality and religiousness have been shown to be highly prevalent in patients with psychosis. Yet the influence of religious denomination as it affects coping methods and/or as an explanatory model for illness and treatment remains to be determined. This study aims (1) to investigate if religious denomination is associated with explanatory models, (2) to assess the evolution over time of these explanatory models, and (3) to examine the relationship between these explanatory models and the spiritual vision of treatment and adhesion to such treatment.

SAMPLING AND METHODS

Of an initial cohort of 115 outpatients, 80% (n = 92) participated in a 3-year follow-up study. The evolution of their religious explanatory models was assessed in order to evaluate if religious denomination, as a meaning-making coping tool, is associated with the patients' explanatory models. Finally, we examined the relationship between these representations and the patients' spiritual visions of treatment and treatment adhesion.

RESULTS

A spiritual vision of the illness (as part of an explanatory model) was more frequent in patients with psychosis for whom the subjective dimension of religion was important. However, there was no association between the patients' religious denomination and their spiritual vision of the illness. The analyses showed that the various contents of spiritual visions of illness were not positive or negative per se; instead, they depended on how this religious vision was integrated into the person's experience. Examining longitudinal aspects of coping showed that the spiritual vision sometimes changed, but was not associated with clinical or social outcome.

CONCLUSIONS

For patients with psychosis, explanatory models frequently involve a religious component which is independent of denomination and likely to change over time. Clinicians should address this issue on a regular basis, by asking patients about their explanatory model before trying to build a bridge with the medical model.

[Sodium intoxication with fatal outcome caused by peritoneal lavage with hypertonic solution of NaCl]

We report a case of fatal sodium poisoning due to the unintentional use of 20% hypertonic saline serum during peritoneal lavage after intestinal resection. The patient presented with unconsciousness, metabolic acidosis, and plasma sodium concentration of 193 mE/l. After 3 hours, he developed paroxysmal supraventricular tachycardia, hyperthermia, generalized tonic-clonic convulsions, disseminated intravascular coagulation, and adult respiratory distress syndrome. The patient died 15 hours after the operation. Pathological examination revealed cerebral and lung oedema, pericentral hepatic necrosis, and fibrin thrombi in the lungs, stomach, and kidneys. We review, in addition, other reported cases of sodium poisoning.

Calcium phosphate precipitation in a SBR operated for EBPR: interactions with the biological process

The aim of this paper is to study the precipitation process in a sequencing batch reactor (SBR) operated for EBPR (enhanced biological phosphorus removal) and the possible effects of this phosphorus precipitation in the biological process. Four experiments were carried out under different influent calcium concentration. The experimental results and the equilibrium study, based on the Saturation Index calculation, confirm that the process controlling the calcium behaviour in a SBR operated for EBPR is the calcium phosphate precipitation. This precipitation takes place at two stages initially precipitation of the ACP and later crystallization of HAP. Also the accumulation of phosphorus precipitated was observed when the influent Ca concentration was increased. In all the experiments the influent wastewater ratio P/COD was kept constant. It has been observed that at high Ca concentration the amount of poly-P granules decrease, decreasing the ratio between phosphate release and acetate uptake (P(rel)/Ac(uptake)). Changes on PAO and GAO populations during the experimental period were ruled out by means of methilene blue stains for poly-P detection. These results confirmed the phosphate precipitation as a process that can affect to the PAO metabolism and the EBPR performance.

[Self aggressive-behaviours in prison]

Suicide among prisoners is a relatively well documented public health issue. On the other hand, data about self-aggressive behaviours in prisons are scarce, despite the fact that this problem seems to be highly prevalent. We conducted a retrospective study over a fifteen months period in a remand prison situated in the French speaking area of Switzerland. During this time period, 161 self-aggressive behaviours were recorded, corresponding to 80 inmates. The most frequent acts were self-cuttings and self-mutilations, followed by strangulations. All these patients were male and their mean age was 25. Some of these behaviours (ingesting cutting objects and sewing of the lips) were specific to some ethno-cultural groups. Copycat behaviours play a significant role in closed communities such as prisons. These results underline the necessity of taking into account self-aggressive behaviours in penitentiary institutions.

Religious beliefs in schizophrenia: their relevance for adherence to treatment

The study examined how religious beliefs and practices impact upon medication and illness representations in chronic schizophrenia. One hundred three stabilized patients were included in Geneva's outpatient public psychiatric facility in Switzerland. Interviews were conducted to investigate spiritual and religious beliefs and religious practices and religious coping. Medication adherence was assessed through questions to patients and to their psychiatrists and by a systematic blood drug monitoring. Thirty-two percent of patients were partially or totally nonadherent to oral medication. Fifty-eight percent of patients were Christians, 2% Jewish, 3% Muslim, 4% Buddhist, 14% belonged to various minority or syncretic religious movements, and 19% had no religious affiliation. Two thirds of the total sample considered spirituality as very important or even essential in everyday life. Fifty-seven percent of patients had a representation of their illness directly influenced by their spiritual beliefs (positively in 31% and negatively in 26%). Religious representations of illness were prominent in nonadherent patients. Thirty-one percent of nonadherent patients and 27% of partially adherent patients underlined an incompatibility or contradiction between their religion and taking medication, versus 8% of adherent patients. Religion and spirituality contribute to shaping representations of disease and attitudes toward medical treatment in patients with schizophrenia. This dimension should be on the agenda of psychiatrists working with patients with schizophrenia.

Successful Treatment of Alcohol Withdrawal with Trazodone

Trazodone, a second generation antidepressant, is helpful in the treatment of lasting alcohol withdrawal symptoms, such as sleep disturbances and craving. We report a case suggesting that trazodone is also efficient for the treatment of the acute phase of alcohol withdrawal treatment. A 30-year-old male patient with severe alcohol withdrawal symptoms was successfully treated with an adjuvant administration of 600 mg trazodone per day, while he had remained symptomatic for several days under high doses of diazepam and clomethiazolum. Controlled trials with trazodone for this indication could be useful.

[Spirituality, religious practices and schizophrenia: relevance for the clinician]

Religion (spirituality and religiousness) is salient in the lives of many people suffering from schizophrenia. In order to assess religious coping in schizophrenia, we developed a clinical grid, as no validated questionnaire exists for this population. Religion had a positive effect for 71% and a negative effect for 14% of the 115 patients interviewed. Religion influences the sense of self, symptoms, social functioning, the comorbidity of substance abuse, suicidal attempts and adherence to treatment. Then religion is relevant for treatment and should be evaluated systematically. The forementioned clinical grid is suitable for this purpose. It proved its applicability to a broad diversity of religious beliefs, even pathological ones. Inter-judge reliability and construct validity were high and specific training is not required.

Calcium effect on enhanced biological phosphorus removal

The role of calcium (Ca) in enhanced biological phosphorus removal and its possible implications on the metabolic pathway have been studied. The experience has been carried out in an SBR under anaerobic-aerobic conditions for biological phosphorus removal during 8 months. The variations of influent Ca concentration showed a clear influence on the EBPR process, detecting significant changes in Y(PO4). These Y(PO4) variations were not due to influent P/COD ratio, pH, denitrification and calcium phosphate formation. The Y(PO4) has been found to be highly dependent on the Ca concentration, increasing as Ca concentration decreases. The results suggest that high Ca concentrations produce "inert" granules of polyphosphate with Ca as a counterion that are not involved in P release and uptake. Furthermore, microbiological observations confirmed that appreciable changes in PAO and GAO populations were not observed. This behaviour could suggest a change in the bacterial metabolic pathway, with prevailing polyphosphate-accumulating metabolism (PAM) at low influent Ca concentration and glycogen-accumulating metabolism (GAM) at high concentration.

[Alpha-thalassemias and bipolar disorders: a genetic link?]

After a previous paper discussing the possible association between beta-thalassemias and bipolar disorder, this article considers a possible association between alpha-thalassemia and the bipolar disorder. We report the case of a 36 year old woman with bipolar disorder and alpha-thalassemia. The patient, native of Reunion Island, has a family history of bipolar disorder (both parents, one brother, and a paternal uncle). The severity of the bipolar disorder type I in her family, is illustrated by the suicides of both parents, one brother and the paternal uncle, in intervals of only a few years. After a Medline review (1980-2004) we found only two studies suggesting a possible relationship between bipolar disorders and alpha-thalassemias, but without clinical case report information. Some genetic studies described the existence of possible genetic susceptibility for bipolar disorder on the short arm of chromosome 16, close to the gene involved in certain alpha-thalassemias, on the region 16p13.3. An interesting finding is that the sequencing of 258 kb of the chromosome region 16p13.3 not only allowed the identification of genes involved in the alpha-thalassemia and in the vulnerability to bipolar disorders, but also the identification of genes implicated in tuberous sclerosis, in polycystic kidney disease, in cataract with microophtalmia, and in vulnerability genetic factors for ATR-16 syndrome, asthma, epilepsy, certain forms of autism and mental retardation. Numerous clinical descriptions and some familial studies on linkage suggested a possible relationship between tuberous sclerosis, polycystic kidney disease, cataract with microophtalmia, ATR-16 syndrome, asthma, epilepsy, certain forms of autism, mental retardation and bipolar disorder, given the closeness of these vulnerability genes on the short arm of the chromosome 16. A vulnerability gene of alcohol dependence was also identified on this same chromosome region (16p13.3), by a study concerning 105 families. Taking into account the methodological difficulties due to the clinical and genetic heterogeneity of bipolar disorder, we suggest that linkage techniques should be used to confirm the presence of susceptibility genetic factor for bipolar disorders on chromosome 16. Thus a known genetic disease (alpha-thalassemia) could contribute to confirming the presence on the short arm of chromosome 16 of a susceptibility genetic factor for bipolar disorders. Linkage studies should be performed in families with a strong association for both diseases. Thanks to linkage techniques, one could hope for an improvement in understanding the physiopathology of bipolar disorder, with possible implications at a therapeutic level.

Synthesis of alkyl chain-modified ether lipids and evaluation of their in vitro cytotoxicity

A series of alkyl lysophospholipid (ALP) analogs of ET-18-OCH3 (1-O-octadecyl-2-O-methyl-rac-glycero-3-phosphocholine) containing modifications in the long C-1 chain has been synthesized and evaluated in human tumor cell line cytotoxicity assays. The compounds have also been evaluated in platelet activating factor (PAF) receptor agonism and hemolysis tests. Two modifications have been studied, introduction of a carbonyl group at different positions of the C-1 chain and branching of this chain, in some compounds with incorporation of a phenyl group. Several compounds showed a cytotoxic potency comparable to that of the reference compound ET-18-OCH3, associated with reduced proaggregating and hemolytic effects. The two enantiomers of 1-O-(7-oxooctadecyl)-2-O-methyl-rac-glycero-3-phosphocholine (2) showed the same level of cytotoxicity or antiproliferative activity, with the PAF-agonistic effect confined to R-2. The very low stereoselectivity found in the in vitro cytotoxicity confirms earlier results and indicates a lack of stereospecific interactions with a macromolecular target.