Clinical outcomes of a coping with stress training program among patients suffering from schizophrenia and schizoaffective disorder: a pilot study

This study evaluated the clinical effects of an intervention aimed at enhancing specific self-efficacy for coping with stress (CSSE) among patients with psychosis. Fourteen patients, 21–60 years old, diagnosed with schizophrenia or schizoaffective disorder voluntarily participated and were randomly assigned to a training and a control group. The Brief Psychiatric Rating Scale-24 was used to assess psychotic symptoms (primary outcomes) at baseline, post-intervention, and three- and six-month follow-ups. The participants also completed self-reports on well-being and satisfaction with intervention outcomes (secondary outcomes) at post-intervention and at the two follow-up assessments. Trained patients showed a significant decrease in all measures of psychotic symptoms (for disorientation, not significant (NS); effect sizes up to d = 4.80). This decline in symptoms remained significant at the follow-ups, with clinical enhancements on some of the subscales. By contrast, control participants showed no significant change in their symptoms. Short- and long-term overall well-being and satisfaction with outcomes were higher among the participants who received the training program. Our findings point out the relevance of enhancing CSSE among patients with psychosis, along with enhancing their coping skills for managing their illness. We conclude that CSSE training should be considered in future therapeutic interventions for psychotic disorders.     

Evaluation of Symptoms and Alexithymia in Psychiatric Patients: A Naturalistic Longitudinal Study in a Day Hospital

This study aimed to examine the effectiveness of a time-limited (10 months), combined individual and group treatment in a Day Hospital (DH) setting. Participants (N = 73) completed measures of general symptoms and alexithymia. We hypothesized improvements in these symptoms at the end of the overall therapeutic treatment. Results showed significant improvement in ability to identify and describe emotions and feelings, and in general symptoms. Differences in age and personality disorders were found at the end of the treatment: younger patients had less difficulty in identifying emotions, and psychotic patients have higher difficulty to describe feelings compared to patients with personality disorders. Furthermore, patients with schizophrenia had lower pathological symptoms compared to patients with mood disorders. This naturalistic longitudinal study demonstrates that DH treatments in group setting increase the patient‘s ability to symbolize and to connect their symptoms to thought and emotions.     

Assessment of Psychotic Disorders in Inpatient Children and Adolescents: Use of the Devereux Scales of Mental Disorders

The Devereux Scales of Mental Disorders (DSMD), with its 3-factor model of measurement (i.e., Internalizing, Externalizing, and Critical Pathology), may be useful in screening for psychotic disorders in children. This study assessed the ability of the DSMD to differentiate between inpatient children and adolescents with psychotic disorders (n = 18) and those with other clinical syndromes (n = 71). Results of ANCOVAs indicated that the psychotic group scored significantly higher on most DSMD scales and composites than the nonpsychotic clinical group. However estimates of effect size were particularly large for the Critical Pathology Composite and the Autism and Acute Problems Scales. Diagnostic efficiency statistics revealed that the DSMD's Critical Pathology Composite was highly accurate in differentiating between the 2 clinical groups. These findings support the utility of the DSMD in identifying children and adolescents with psychotic disorders.     

Short-term homogeneous group therapy for schizophrenic inpatients: A questionnaire evaluation

Traditional, insightoriented group therapy with a heterogeneous patient population has not been effective in the short-term inpatient setting. We have experimented with a homogeneous group therapy format where all of the patients have been acutely psychotic schizophrenics. Clinically, this approach has been found to be useful. Questionnaires filled out by the patients at the time of discharge have supported this conclusion. The patients valued the group more as a place to express their feelings and learn ways of interacting with others than as a place to test reality or receive advice on practical issues.     

Does Symptom Type Moderate the Relationship Between Insight and Outcome in Cognitive Behavioral Therapy for Psychosis? A Preliminary Investigation

Insight has emerged as a potential predictor variable in cognitive behavioral therapy for psychosis (CBTp). However, previous research has produced mixed results. The present study aimed to clarify whether symptom type is a moderating variable. A group of psychotic patients (n = 44) were assessed through pre- and post-treatment in a CBTp specialty track in a partial hospital-based program in the USA. The Insight Scale was used to measure insight, and psychotic symptomatology was assessed using the Mini-International Neuropsychiatric Interview and the Behavior and Symptom Identification Scale. Patients showed a significant decrease in psychotic symptom scores over the course of treatment [t(43) = 3.59, p < .001, Cohen's d = .64]. Furthermore, illness awareness was specifically associated with a decrease in psychotic symptoms for patients who endorsed visual hallucinations (r = ? .68, p < .01), auditory hallucinations (r = ? .49, p = .01), and/or ideas of reference (r = ? .66, p < .01). Insight did not confer additional benefit for patients with paranoid delusions, mind reading, or thought insertion symptoms. These results are discussed in relation to treatment implications within the current US health care delivery system.     

布托啡诺预处理对减轻精神病患者MECT肌痛的作用

探讨对精神病人无抽搐电休克治疗（modified electroconvulsive therapy,MECT）后肌痛的治疗效果。选择我院MECT病人120人次,随机分为对照组和治疗组,于异丙酚复合琥珀胆碱静脉麻醉下进行MECT。治疗组病人在麻醉前5min静注布托啡诺1mg,结果显示,布托啡诺预处理可有效减轻精神病人MECT后的肌痛程度。     

Introducing the living with illness group: A specialized treatment for patients with chronic schizophrenic conditions

This paper introduces a specialized psychotherapy/psychoeducational group treatment for patients with chronic psychotic symptoms who receive only partial benefit from psychotropic medications, psychotherapy, and milieu/activities therapy. The goal of the group is to assist patients to accurately identify the feelings, thoughts, and behaviors that are dysfunctional symptoms of their disability and then use the functional aspects of their brain as well as learned coping strategies to compensate for their disability. The group format, philosophy, procedures, and typical topics of discussion are detailed.The authors would like to thank Bruce Levine, Ph.D., and Terry Fujeoko, Ph.D., for their assistance with the initial formation of the group. Mr. Howe and Dr. Fujeoko originated the Living with Illness group and began the first group in 1985 at Waterbury Hospital Health Center, Waterbury, CT.     

Social cognition and real-life functioning in patient samples with 22q11.2 deletion syndrome with or without psychosis,compared to a large sample of patients with schizophrenia only and healthy controls

Patients with the 22q11.2 deletion syndrome (DS) show an increased risk of developing a psychotic illness lifetime. 22q11.2DS may represent a reliable model for studying the neurobiological underpinnings of schizophrenia. The study of social inference abilities in a genetic condition at high risk for psychosis, like 22q11.2DS, may shed light on the relationships between neurocognitive processes and patients' daily general functioning. The study sample consisted of 1736 participants, divided into four groups: 22q11.2DS patients with diagnosis of psychotic disorder (DEL SCZ, N = 20); 22q11.2DS subjects with no diagnosis of psychosis (DEL, N = 43); patients diagnosed with schizophrenia without 22q11.2DS (SCZ, N = 893); and healthy controls (HC, N = 780). Social cognition was assessed through The Awareness of Social Inference Test (TASIT) and general functioning through the Specific Levels of Functioning (SLoF) scale. We analysed data through regression analysis. The SCZ and DEL groups had similar levels of global functioning; they both had significantly lower SLoF Total scores than HC (p < .001); the DEL SCZ group showed significantly lower scores compared to the other groups (SCZ, p = .004; DEL, p = .003; HC, p < .001). A significant deficit in social cognition was observed in the three clinical groups. In the DEL SCZ and SCZ groups, TASIT scores significantly predicted global functioning (p < .05). Our findings of social cognition deficit in psychosis-prone patients point to the possible future adoption of rehabilitation programmes, like Social Skills Training and Cognitive Remediation, during premorbid stages of psychosis.     

Fragments of a Case of Psychosis: From Institutional Sheltering to Psychoanalytical Experience

This article describes a psychoanalytical experience that took place in an institution for mental health, located in Rio de Janeiro, Brazil. There, an art workshop was created in an attempt to welcome and shelter psychotic patients. This work space later proportioned a ''setting'' for the practice of psychoanalysis with psychotic patients. In the clinical case, herein examined, the author dedicates special attention to the relation that exists between certain psychotic aspects and the process described by Jacques Lacan as: the ''foreclosure of the name of the father''.     

Can anybody hear me? Reacting to pressures from psychotic states of mind

In this paper material is presented from supervision groups run for nurses and other mental health professionals. The patients presented to the group all came from different mental health settings and suffered from psychotic states of mind. In this paper I will argue that the psychodynamic model can help nurses and other front‐line mental health professionals in their understanding of psychotic process. Nursing staff, in particular, are with their patients over long periods of time and see them in different settings. The psychodynamic model can be helpful in giving mental health professionals a language for describing their experiences of, and interaction with, their patients. The psychodynamic model can also provide a dynamic picture of the patient's problems over time. This type of assessment and thinking, which includes an understanding of the dynamic process involved in psychosis, can then stand alongside the medical model.     

Context-processing deficits in schizophrenia: diagnostic specificity, 4-week course,and relationships to clinical symptoms

Previous research on schizophrenia suggests that context-processing disturbances are one of the core cognitive deficits present in schizophia. However, it is not clear whether such deficits are specific to schizophrenia as compared with other psychotic disorders. To address this question, the authors administered a version of the AX Continuous Performance Test designed to assess context processing in a sample of healthy controls, patients with schizophrenia, and patients with other psychotic disorders. Participants were tested at index (when medication naive and experiencing their first contact with psychiatric services) and 4 weeks later, following medication treatment. At index, patients with schizophrenia and the psychotic comparison group demonstrated similar impairments in context processing. However, context-processing deficits improved in the psychotic comparison group at 4 weeks but did not improve in patients with schizophrenia.     

Schizotypy and hemisphere function—II : Performance asymmetry on a verbal divided visual-field task

Following reports that psychotic patients show abnormal performance asymmetries on divided visual-field (DVF) tasks, a study was made of the relationship between performance asymmetries on a verbal DVF task in a group of normal Ss (18 male, 18 female) and self-report measures of personality. Interest was focused primarily on a new questionnaire, the STQ, which purports to provide measures of both ‘schizotypal’ and ‘borderline’ personality. It was hypothesized that high scoring on the ‘schizotypal’ scale would be associated with attenuation of performance asymmetry on the DVF task. The hypothesized correlation was found for males but not for females. The results are discussed in the context of theoretical issues central to the DVF method and are taken generally to support a continuity model of psychosis.     

Group analytic therapy with schizophrenic outpatients

This paper describes a model for group analytic psychotherapy with patients who have been psychotic, namely, schizophrenics and manic depressives. The groups are run on the group centered principles of S. H. Foulkes. They are continuous, slow-open groups, in line with these patients' needs for long-term therapy. A theory is proposed which justifies treating these patients in group-centered groups despite their great dependency needs. The paper also describes the task of the therapist in building and running such a group.Acknowledgments to Geoffrey Elkan, Marcia Levene, Noa Rotem, Aya Levi-Posnanski, Yossi Ezrati, S. Littman, Tamar Sternberg, E. Danilowitz, and C. Kauffman.     

Severity of Self-Reported Depression in Patients with a Schizoaffective Disorder

  To investigate the severity of self-reported depression in patients diagnosed with a schizoaffective disorder (SZA), the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) was administered to 75 patients with a SZA. For comparative purposes, the BDI-II was also administered to 75 patients with a major depressive disorder without psychotic features (MDD) who were matched to the SZA sample with respect to sex, being Caucasian, and age. The Cronbach coefficient αs of the BDI-II total scores for the patients with a SZA or a MDD were, respectively, .94 and .92. The mean BDI-II total score (M = 23.71, SD = 15.44) of the patients with a SZA was minimally lower than the mean BDI-II score (M = 28.73, SD = 12.46) of the patients with a MDD. The BDI-II was discussed as being useful for assessing self-reported depression in patients diagnosed with a SZA.     

Sexualdelinquenz bei Schizophrenie

Studies suggest a complex relationship between schizophrenia and sexually offensive behaviour. This study aimed to preserve first findings of sex offence features and behaviours exhibited by psychotic men in Germany. Furthermore a typology of the schizophrenic offender group was developed. A comparative trial design was used to differentiate the psychotic and non psychotic offender group. A checklist was developed and applied to the records of 64 male restricted hospital order in-patients in Berlin with an index conviction for a contact sex offence against a woman. Social isolation, antisocial behaviour, psychosexual variables and adverse childhood experiences are found for schizophrenic and sexual offenders in general. Different sexual offensive behaviours appeared in the schizophrenic subgroups. Negative symptoms of schizophrenia as well as antisocial traits had a great impact on schizophrenic sexual offending. A heterogeneous group of psychotic offenders can be supposed.     

Group rounds in a day-night therapeutic clinic for psychiatric patients

The role of the group in the day-time clinic is presented, based on a more 10 years experience with this species of round, with the respects to a biopsychosocial concept of illness, to some reactions of patients, to rehabilitation, to compliance and to mediation of information; on the importance pour the psychotherapy os psychotic patients is oriented.     

Personality Disorders in Older Adult Inpatients with Chronic Mental Illness

It has been hypothesized that some types of personality disorders tend to remit with age whereas others may become more prominent. The present study determined the prevalence and nature of 13 personality disorders with a self-report inventory (Coolidge Axis II Inventory) in an older group of chronically mentally ill inpatients (N = 30, mean age = 63 years) and a younger group of similar patients (N = 30, mean age = 39 years). All patients met DSM-IV criteria for either Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, or recurrent severe Major Depression with psychotic features. The prevalence rate of personality disorders was high for both groups: 58% for the older sample and 66% for the younger group. The younger group was more likely to be diagnosed Antisocial, Borderline, Passive-Aggressive, Sadistic, and Schizotypal, but the groups were not different in the rates of Obsessive-Compulsive Disorder. This study supports the hypothesis that some personality disorders remit with age. However, no evidence was found to suggest that other personality disorders become more prominent in older adult psychiatric populations. Suggestions for future research are offered.     

When groups have a lot to lose: Historical continuity enhances resistance to a merger

In two studies, we examined how perceptions of historical continuity affect group members' responses when their group is facing an upcoming merger. We found that perceived historical continuity was a unique predictor of resisting an upcoming merger between various army regiments in Scotland among those associated with the Black Watch (Study 1; N = 308) and those associated with a range of Scottish army regiments (Study 2; N = 498). We found that the perceived break with the past that the merger would involve mediated the relationship between historical continuity perceptions and merger resistance. However, we also found that when there was some reassurance that historical continuity of the pre‐merger group would be preserved in the merged context (i.e. regiments could keep their pre‐merger names), resistance to the merger was reduced (Study 2). We conclude that historical continuity perceptions can be a resource for groups that they will strive to protect in the face of future identity change. The findings underline the important role of group history perceptions in understanding present group dynamics. Copyright © 2010 John Wiley & Sons, Ltd.     

Adolescent Multiphasic Personality Inventory and Its Utility in Assessing Suicidal and Violent Adolescents

Adolescent Multiphasic Personality Inventory profiles of inpatient adolescents were examined to identify differences between suicidal (danger to self, n = 145) and violent (danger to others, n = 36) adolescents. Participants were 181 inpatients (12–17 years old, mean age, 14.7 years) admitted to an adolescent psychiatric unit of a southern California county hospital. Results indicate that the suicide group had significantly higher scores than the violent group on five scales (Hypochondriasis, Psychasthenia, Paranoia, Schizophrenia, and Social Introversion). These scales, singly or in combination, have been found to be indicative of psychotic process. This suggests the presence of psychotic process in suicidal, but not violent, adolescents.     

The Experience of Caregiving Among Mothers of Adults Suffering from Psychotic Disorders: Factors Associated with Their Psychological Distress

To identify correlates of psychological distress among multiple indicators, 99 women with adult children suffering from a psychotic disorder were interviewed. The women, who were recruited through hospitals and self-help groups, represented different socioeconomic levels. A face-to-face standardized interview was conducted, mainly in the participants' homes. Multiple hierarchical regression analysis showed that dimensions of burden and social support were strongly associated with distress reported by the participants. The negative interactions that participants had with their main confidant or spouse constituted a more powerful correlate than their perception of the quality of this relationship. Furthermore, a perception of their own health as poorer is a strong correlate of their distress. Since no control group was studied simultaneously, these results suggest, but do not prove, the presence of differences between mothers of adults with psychotic disorders and other mothers.