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.     

Consciousness in Schizophrenia: A Metacognitive Approach to Semantic Memory

Recent studies have shown that schizophrenia may be a disease affecting the states of consciousness. The present study is aimed at investigating metamemory, i.e., the knowledge about one's own memory capabilities, in patients with schizophrenia. The accuracy of the Confidence level (CL) in the correctness of the answers provided during a recall phase, and the predictability of the Feeling of Knowing (FOK) when recall fails were measured using a task consisting of general information questions and assessing semantic memory. Nineteen outpatients were paired with 19 control subjects with respect to age, sex, and education. Results showed that patients with schizophrenia exhibited an impaired semantic memory. CL ratings as well as CL and FOK accuracy were not significantly different in the schizophrenic and the control groups. However, FOK ratings were significantly reduced for the patient group, and discordant FOK judgments were also observed more frequently. Such results suggest that FOK judgments are impaired in patients with schizophrenia, which confirms that schizophrenia is an illness characterized by an impaired conscious awareness of one's own knowledge.     

Applications of Trauma Treatment for Schizophrenia

Because of the high rates of trauma and posttraumatic stress disorder in individuals with psychotic disorders, there has been increasing emphasis on incorporating trauma treatment into comprehensive care for schizophrenia. Yet, despite heightened awareness of the need, limited information has been provided specifying an effective approach tailored to this population. Significant advances in trauma treatment have been made in recent years that can provide a general framework for guiding such interventions for individuals with schizophrenia. This article provides a brief review of the relationship between trauma and schizophrenia and offers a heuristic view of applications of current trauma treatment to psychotherapy for schizophrenia.     

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.     

Poly I:C母体免疫刺激诱导的子代精神分裂症神经发育动物模型研究

精神分裂症是一组病因未明的重性精神障碍,其病理生理学机制极其复杂,建立能够确切模拟精神分裂症的动物模型对于其发病机制的研究及抗精神分裂症药物的研发具有十分重要的意义。本文意在介绍产前母体免疫刺激（聚肌胞苷酸聚肌苷酸-聚胞苷酸,poly-I:C）诱导子代出现精神分裂症样的神经发育动物模型,以及该模型对精神分裂症的病因研究、生物学机制及其治疗和药物研发的重要意义。     

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。     

Mothering Children with Schizophrenia in a Village Setting: A Multiple Case Study

This study reports on the experiences of mothers (n=8) raising children with schizophrenia in a rural South African village. The mothers were individually interviewed at their homes, using in-depth, phenomenological methods. Data were thematically analysed. Mothers of children with schizophrenia indicated that they are facing the following challenges on their process of caregiving: mothers' emotional reactions, blaming witchcraft, dealing with the children's violence and destructiveness, poverty and unemployment, financial support, isolation and social support, effects of schizophrenia on the mother-child relationship, and the loss that mothers go through.     

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.     

Schizophrenia,psychoeducation and group psychoanalysis: Contributions and limitations

Schizophrenia involves difficulties with aspects of relating that make traditional psychotherapeutic practices more difficult. Drawing on the observation of a psychoeducation group comprising 10 patients with schizophrenia (primarily paranoid schizophrenia) we highlight group processes that help show how the conduct of psychoeducational groups can benefit from a group therapy approach. In the research example discussed, we review a psychoeducation group which took place over a period of one year at a day hospital, facilitated by professionals trained in psychoanalytic group psychotherapy.     

执行功能与精神分裂症

执行功能障碍是精神分裂症最重要的认知功能障碍,与精神分裂症其它方面的障碍有着密不可分的关系。文章在相关的认知神经心理学和临床研究的基础上,分别综述了精神分裂症执行功能障碍的特点、研究方法、相关脑机制,执行功能与注意、记忆等一般认知功能间的关系,执行功能与精神症状间的联系及其在诊断、康复、判断预后方面的作用等。对精神分裂症执行功能障碍的认识有助于更深入地理解其病因机制,并有利于临床评价与防治     

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。     

精神分裂症患者的记忆损害

摘 要 目的 探讨精神分裂症患者记忆损害状况。方法 采用修正的加工分离记忆实验程序,分别测试精神分裂症患者和正常对照组的记忆能力。结果 （1）精神分裂症患者外显记忆功能存在广泛的缺陷,而内隐记忆功能缺陷只在概念驱动下的测验中出现。（2）以阳性症状为主的精神分裂症患者的外显记忆成绩均高于以阴性症状为主的精神分裂症患者。(3)阴性症状严重程度与外显记忆成绩呈显著负相关。结论 精神分裂症患者的内隐记忆功能相对完整,而外显记忆障碍在以阴性症状为主的精神分裂症患者尤为突出。     

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.     

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.