Culturally Adapted Psychosocial Interventions for Schizophrenia: A Review

Recent research examining the potential efficacy of culturally adapted interventions for various mental disorders illustrates increasing interest in the integration of cultural perspectives into mental health systems. Despite recent evidence demonstrating that culturally adapted interventions may be more effective than a one-size-fits-all approach, few psychosocial treatments for schizophrenia consider cultural factors that may enhance their efficacy with diverse populations. The aim of this review is to discuss the empirical evidence examining the potential utility of culturally adapted group interventions for schizophrenia, as a means to encourage further work and expansion in this area. Specifically, this article provides an in-depth review of the empirical literature on culturally adapted psychosocial interventions for individuals with schizophrenia and their family members, with a focus on group-based interventions. This review is followed by a discussion of a few cultural constructs that may impact patient and family member functioning, and therefore may be important to address in psychosocial treatments for schizophrenia. Finally, we end this review with a broad discussion of research limitations and potential areas for additional research, clinical implications for adapting EBTs to better address cultural concerns, and a case vignette to illustrate how cultural considerations can be integrated into a traditional multifamily group therapy approach.     

Phencyclidine (PCP): A Dangerous Drug,but Useful in Schizophrenia Research

Phencyclidine (PCP) is a dangerous drug, and the federal government has placed it on Schedule II of the Controlled Substance Act (see http://www.mninter.net/～publish/csa2.htm#Schedule%20III). Typically, users smoke PCP, and it is often mixed with parsley, marijuana, or cocaine. Most researchers have conducted experiments on animals rather than on people, and a few have been done on persons diagnosed with schizophrenia, so answers to questions about its addictive potential or development of tolerance are not clear. In healthy volunteers, PCP can induce symptoms that mimic those of schizophrenia, lasting from a few days to more than a week. The neurotransmitter glutamate and N-methyl-D-aspartate (NMDA) appear to play a role in the mechanism by which PCP induces positive and negative schizophrenic symptoms and cognitive defects (D. C. Javitt & S. R. Zukin, 1991; A. Lahti, B. Koffel, D. LaPorte, & C. A. Tarnminga, 1995; T. W. Robbins, 1990). Because PCP can induce symptoms that are almost indistinguishable from those associated with schizophrenia, further research may lead to new medications that could be helpful to people who do not respond to neuroleptics that are currently available.     

John Nash's Delusional Decade: A Case of Paranoid Schizophrenia

Continues the psychoanalytic study of mathematical genius John Nash in Capps (2003) by focusing on the decade, during his thirties, when he was most delusional. Explores the connections between the content of his delusions and his life history and immediate circumstances, with particular attention to the way in which his delusions reflected the bisexual confusion discussed in the previous essay. Uses Freud's analysis of the mechanism of paranoia in his Dr. Schreber study to account for the nature and progression of Nash's delusions.     

Schizophrenia: An Update and Review

Schizophrenia is a common complex disorder characterized by psychosis, cognitive dysfunction and negative symptoms, whose etiology involves interactions between both genetic and environmental vulnerability factors. Recently, ongoing research attempting to elucidate the nature of these vulnerability factors has been generating exciting findings. The advances in understanding of environmental risk factors for mental illnesses and in genetic research into mental illnesses will be reviewed. Limitations of the findings and implications of these advances for genetic counseling practice will also be discussed.     

精神分裂症心理社会治疗

药物治疗虽然能改善精神分裂症的许多显性症状,而复发、残留症状和功能衰退单靠药物是不能解决的。从现代医学的角度看精神分裂症的预防与康复应该采取整体、多维度、综合性预防和康复措施,在进行生物学治疗的同时给予心理社会治疗,使病人达到最好的疗效。     

Approaches to Cognitive Remediation of Neuropsychological Deficits in Schizophrenia: A Review and Meta-Analysis

A review and critique of the literature pertaining to the use of cognitive remediation techniques in patients with schizophrenia is presented. The review is organized into three sections, according to the neuropsychological deficit targeted for remediation: 1) executive-function, 2) attention, and 3) memory. With regards to executive-function, despite an initial report suggesting that Wisconsin Card Sorting Test performance cannot be remediated, subsequent studies suggest that performance can be improved on a variety of dependent measures including perseverative errors, categories achieved, and conceptual level responses. These observations were confirmed by a meta-analytic investigation that revealed large mean effects sizes (d ₊ = 0.96) for these studies. Effect sizes were homogenous across discrepant remediation strategies and dependent measures. With regards to attention, serial scanning can be improved with instruction and reinforcement, whereas there is mixed evidence suggesting that practice-based attention drills can improve performance on measures of sustained attention in schizophrenia. With regards to memory, relatively simple semantic and affective elaborate encoding strategies elevates verbal list-learning memory in patients with schizophrenia to levels consistent with controls. A similar encoding procedure, combined with vigilance training, produces substantial improvement in social cue recognition. Avenues for future research are discussed.     

精神分裂症遗传学内表型研究的启示

精神分裂症是一种常见的重性精神障碍,属于复杂的多基因遗传性疾病。随着分子生物学技术和遗传学数据分析方法的进步,精神分裂症易感基因方面的研究取得了一定的进展,但是至今还没有一个精神分裂症的易感基因得到准确定位。近年来精神分裂症的遗传学研究中越来越多地引入了内表型概念,而旨在阐明不同的基因变异引起精神疾病的相应功能障碍的内表型研究将为分裂症的诊断和治疗提供了较为客观的生物学指标,也对该复杂疾病的病因学、诊断和治疗学产生重要影响。     

Compounding Vulnerability: Pregnancy and Schizophrenia

The predominant ethical framework for addressing reproductive decisions in the maternal–fetal relationship is respect for the woman's autonomy. However, when a pregnant schizophrenic woman lacks such autonomy, healthcare providers try to both protect her and respect her preferences. By delineating etic (objective) and emic (subjective) perspectives on vulnerability, I argue that options which balance both perspectives are preferable and that acting on etic perspectives to the exclusion of emic considerations is rarely justified. In negotiating perspectives, we balance the etic commitment to protect the vulnerable patient and her fetus from harm with the emic concern to empower a decisionally incapacitated woman. Equilibrium is best achieved by nurturing interdependent relationships that empower and protect the vulnerable woman. The analysis points to the need for better social support for mentally ill patients.     

精神分裂症遗传学研究的理性思辨

精神分裂症是一种常见的重性精神障碍,属于复杂的多基因遗传性疾病。随着分子生物学技术和遗传学数据分析方法的进步,精神分裂症易感基因方面的研究取得了一定的进展,但是至今还没有一个精神分裂症的易感基因得到准确定位。系统生物学是采用系统科学的方法研究一个生物系统的一种大科学,为寻找精神分裂症等复杂疾病的易感基因提供一种新的思路。     

Sources of Heterogeneity in Schizophrenia: The Role of Neuropsychological Functioning

Although schizophrenia is often characterized as a heterogeneous disorder, efforts to validate stable and meaningful subtypes have met with limited success. Thus, the issue of whether schizophrenia reflects a continuum of severity or a number of discrete subtypes remains controversial. This review evaluates efforts to establish subtypes based upon a model that includes causes, characteristics, and course and outcomes of heterogeneity. Emphasis is placed on empirical classification studies utilizing cognitive tests or symptom rating scales, sometimes in conjunction with neuroimaging procedures. Results of recent cluster analytic studies are reviewed that produced evidence of four or five clusters, varying in level and pattern of performance. Although this research typically generated meaningful subtypes, it was often the case that there was little correspondence between subtyping systems based upon cognitive function and those based upon symptom profile. It was concluded that there may be different mechanisms for producing cognitive and symptomatic heterogeneity, and that diversity in presentations of schizophrenia reflects a combination of continuities in severity of the disorder with a number of meaningful and stable subtypes.     

Schizotypy: An Organizing Framework for Schizophrenia Research

ABSTRACT— Schizophrenia is the most devastating form of psychopathology known to humankind, and it has been slow to yield clues to its origins. Meehl's (1962, 1990) model detailed the nature of the latent liability for schizophrenia known as schizotypy and provided a major organizing function for research on schizophrenia. The schizotypy model integrates genetic and environmental contributions to liability as well as accounting for a range of clinical outcomes, all deriving from a genuine liability for the illness. Schizotypy, as a latent personality organization that harbors the liability for schizophrenia, provides a framework for detecting fundamental features of liability to schizophrenia prior to the onset of clinical illness. The schizotypy model is reviewed, the strategic benefits of it are discussed, and methods for detecting schizotypy are presented. A focus on perceptual aberrations—a schizotypic feature—in individuals unaffected by schizophrenia has yielded valuable clues to preclinical disturbances in neurocognitive processes, risk for schizophrenia among biological relatives, and genomic substrates, all of which are of interest to schizophrenia researchers.     

精神分裂症神经影像学研究述评

全世界约有1%的人患有精神分裂症,对患者及其家人造成了严重负担。由于此病影响因素很多,精神分裂症研究进展所取得的进步有限。精神分裂症产生的物质基础在脑,神经影像技术的进步为我们直接研究此病活体脑部结构及功能提供了良好的工具。本文主要从四个方面介绍了神经影像学在精神分裂症的研究及所贯彻的哲学思想。     

A Meta-Analysis of Cognitive Deficits in Adults with a Diagnosis of Schizophrenia

This review identified 1275 studies examining cognitive deficits in people with schizophrenia, published between 1990 and 2003. Data from 113 studies (4365 patients and 3429 controls) were combined in a meta-analysis carried out on the five cognitive domains of IQ, memory, language, executive function, and attention. Studies were excluded where they lacked a suitable control group or failed to present complete information. In all five cognitive domains, analysis indicated a consistent trend for patients to perform more poorly than healthy controls, with significant heterogeneity across studies. Sources of heterogeneity were analyzed and a need to ensure more appropriate composition of patient and control groups and to adopt a more refined and methodologically correct, hypothesis-driven approach was identified.     

Schizophrenia and the Developmental Moratorium

Jay B. Sisun is a Clinical Research Assistant at Taunton State Hospital. Glen A. Eskedal is the Chair and Professor of Education and Human Services at Suffolk University. Of challenge to developmental psychologists and mental health practitioners is the management of positive and negative symptoms associated with schizophrenia and their effects on mastering psychosocial developmental tasks. The intent of this article is to provide specific information pertinent to understanding this disorder, to understand the age-appropriate struggle for individuation, and to offer recommendations for effective treatment.     

The Fear of Understanding Schizophrenia and Iatrogenic Myths

Empirically, psychotherapy with a competent therapist is the optimal, but rarely offered treatment, for schizophrenia. Medication or ECT produces less disturbing, lifelong cripples. Within 25 years one-third spontaneously recover completely (unless they stay on medication), and another third socially recover. Nazi Germany sterilized and annihilated patients without decreasing mental disorders in the next generation. Schizophrenia is a terror syndrome. The therapist must create a therapeutic alliance by creating hope and tolerating not understanding. Hallucinations are waking dreams. Delusions are transferences, defenses against pseudohomosexuality, family-specific meanings, or attempts to make sense out of strange experiences.     

Schizophrenia and indeterminacy: The problem of validity

The paper attempts to account for the confusion over the validity of the concept of schizophrenia in terms of two closely related aspects of conceptual indeterminacy. Firstly, it is identified on the basis of a breakdown in intelligibility, but what constitutes such a breakdown is indeterminate. Secondly, the concept sits between the categories of natural disease or illness on the one hand, and character trait or moral failing or gift on the other. This entails an indeterminacy in attempting to define the role that physiological explanation could have. Light may be thrown on the concept by exploring a distinction between a life story in which the schizophrenic condition emerges as the conclusion of the story and a causal process in which the condition is the end result or final consequence.     

Maternal Representations of Patients with Schizophrenia as Measured by the Parental Bonding Instrument

Maternal perceptions were assessed, using the Parental Bonding Instrument (PBI) in 19 subjects with schizophrenia, 14 subjects with borderline personality disorder and 15 non-clinical subjects. Subjects with schizophrenia and subjects with borderline personality disorder reported significantly less care and more overprotection than did non-clinical subjects. No significant differences were found in representations by subjects with schizophrenia and subjects with borderline personality disorders. To the extent that the reported negative maternal behaviour gives a true picture of childhood and adolescent experiences, it does not seem to be specific for schizophrenia, but may be one factor in the development of severe mental disorders.     

未婚精神分裂症住院患者父母控制感的质性研究

子女罹患精神分裂症对父母是巨大的冲击,本研究采用解释现象学研究方法,对武汉市某精神卫生中心病房住院治疗的6例未婚精神分裂症患者的父母进行深入访谈、现场录音和笔录,并分析资料。结果显示未婚精神分裂症患者住院期间控制感是父母的核心情绪体验,当失去控制感时,家属会体验到恐惧、焦虑、愤怒、自责,乃至抑郁,而当具有控制感时,家属则会体验到放松。提示专业人员在临床工作中需要考虑增强患者家属的控制感,这样可以促进家属的参与性,乃至增加患者的依从性。     

Family Therapy and Childhood-Onset Schizophrenia: Pursuing Clinical and Bio/Psycho/Social Competence

Childhood-onset schizophrenia is perceived as more complicated because of its complexity, pervasive duration, and impact on individual and family functioning. Viewing the symptoms of childhood schizophrenia as creating a bio/psycho/social competence within which the therapist and family must interact may help contribute to treatment success. Competent family therapists working within this culture should be knowledgeable about the characteristics of childhood-onset schizophrenia, aware of their own biases towards psychosis, and skillful in its treatment. Guidelines are provided to help therapists identify their attitudes about schizophrenia and understand appropriate skills for treating the disorder.