Patterns of maternal responding in postpartum mothers with schizophrenia

Little is known about how schizophrenia might affect how a mother responds to her infant, such as whether responding is reduced or impaired. The aim was to identify, from brief videotaped interactions, whether the responses of mothers with schizophrenia were fewer, less positive, more negative, and more ‘abnormal’ than mothers with affective disorder, and whether their infants (mean age: 15 weeks) lacked activity or initiation to which mothers could respond. Mothers with schizophrenia (N = 14) were as responsive as mothers with affective disorder (N = 31), but they showed markedly low positive responsiveness. Only the schizophrenia group exhibited non-responses as a result of being psychologically withdrawn from the interaction, and abnormal behaviors. Inconsistent to our hypothesis, infants in both groups showed similar levels of activity, initiative and negativity. The findings highlight the need for further research to examine the contribution of maternal response impairments to the developmental vulnerability of this genetically high-risk group.     

Attachment theory: a framework for understanding symptoms and interpersonal relationships in psychosis

We investigated associations between adult attachment, symptoms and interpersonal functioning, including therapeutic relationships in 96 patients with psychosis. Using a prospective design, we also assessed changes in attachment in both psychiatrically unstable and stable groups. We measured attachment using the Psychosis Attachment Measure (PAM) and interpersonal problems and therapeutic relationships were assessed from both psychiatric staff and patient perspectives. Avoidant attachment was associated with positive symptoms, negative symptoms and paranoia. Attachment ratings were relatively stable over time, although changes in attachment anxiety were positively correlated with changes in symptoms. Predicted associations between high levels of attachment anxiety and avoidance and interpersonal problems were supported, and attachment avoidance was associated with difficulties in therapeutic relationships. Findings suggest that adult attachment style is a meaningful individual difference variable in people with psychosis and may be an important predictor of symptoms, interpersonal problems and difficulties in therapeutic relationships over and above severity of illness.     

Environmental control and psychosis-relevant traits modulate the prospective sense of agency in non-clinical individuals

The sense of agency concerns the experience of being the source of one’s own actions and their consequences. An altered sense of agency can occur due to task automation and in psychosis. We tested in a non-clinical sample the hypothesis that reducing voluntary task control diminishes intentional binding as an implicit indicator of the sense of agency, possibly interacting with psychosis-relevant personality traits. Agent-device interactions were manipulated obtaining positive-control (voluntary interaction), no-control (automation), and negative-control (device-commanded interaction) groups. The main results showed reduced prospective intentional binding (predictive coding of action consequences) in the no-control and negative-control groups, compared to the positive-control group. Psychosis-like experiences covaried positively with intentional binding in the no-control group, but negatively in the negative-control group. Moreover, positive-social traits were associated with increased intentional binding in the positive-control group. These findings demonstrate the interplay between environmental and individual differences variables in establishing the implicit sense of agency.     

Imagery and psychotic symptoms: a preliminary investigation

Recent cognitive accounts of psychotic symptoms have suggested that processes involved in the maintenance of emotional disorders may also be implicated in the maintenance of hallucinations and delusions, and particularly emphasise the appraisals of such symptoms as important. Imaginal appraisals have been identified in emotional disorders, and many studies have reported spontaneously occurring images in patients with anxiety disorders. Such images appear to be linked to affect, beliefs and memories. This study examined the occurrence of imagery, using a semi-structured interview, in 35 patients who were experiencing hallucinations and/or delusions and receiving cognitive therapy. The majority of patients (74.3%) reported images, and most of these were recurrent and associated with affect, beliefs and memories. Common themes included images about feared catastrophes associated with paranoia, traumatic memories, and images about the perceived source or content of voices. The theoretical and clinical implications of these findings are discussed and directions for further research considered.     

The Symbiosis between a Mother and Her Schizophrenic Son in a Group Therapeutic Process

Abstract

In psychoanalytical practice important, but less studied, transformative functions are performed by verbal comments which do not correspond to the classic model of mutative interpretations proposed by Strachey. The Authors describe some characteristics of such clinical situations, without coming into the better known categories of variations in technique. Such enunciations seem not to have a “strong”, (already clearly defined) meaning in the mind of the analyst, but contain rather a “weak” semantic potential, which can only develop with the active cooperation of the patient. In the light of these experiences, the Authors reconsider the general nature of psychoanalytical interpretation and emphasize the intersubjective and dialogical nature of the interpretive work carried out in analysis.     

Three Phases of Treatment with Borderline and Psychotic Patients

Three distinct, yet overlapping, phases of treatment emerge when working with some borderline and psychotic patients. This are patients who test the ordinary limits of psychoanalysis, but can profit from its deep exploration. The first phase is colored by acting out, interpersonally and intrapsychically. An analytic envelope of containment is necessary to sustain the treatment. Interpretive holding and containing help the patient find a psychic receptacle capable of detoxifying violent projections. Many of these patients terminate prematurely. The second phase is centered around the patient's defensive use of the death instinct to extinguish or destroy certain parts of their mental functioning. This difficult standoff between parts of the patient's mind becomes replicated in the transference. The third phase reveals the more fundamental problem of paranoid～schizoid anxieties of loss and primitive experiences of guilt. These include fears of persecution and annihilation. Some patients abort treatment in the first or second phase and never work through the phantasies and feelings of loss. Nevertheless, much intrapsychic and interpersonal progress is possible. Given the instability and chaotic nature of these patient's object relations, the analyst must be cautiously optimistic in their work and realize the potential to help the patient even when presented with less than optimal working conditions.     

IntrospectionIntrospection and schizophrenia: A comparative investigation of anomalous self experiences

This paper offers a comparative investigation of anomalous self-experiences common in schizophrenia (defined in Examination of Anomalous Self Experiences (EASE) instrument) and those of normal individuals in an intensely introspective orientation (early 20th-century “introspectionist” psychology). The latter represent a relatively pure manifestation of certain forms of exaggerated self-consciousness (“hyperreflexivity”), one facet of the disturbance of core- or minimal-self (“ipseity” disturbance) postulated as central in schizophrenia. Significant similarities with schizophrenia-like experience were found but important differences also emerged. Affinities included feelings of passivity, fading of self or world, and alienation from thoughts, feelings, or lived-body. Differences involved confusion between self and world and severe dislocation or erosion of first-person perspective, qualities unique to schizophrenia. The purpose is threefold: 1, place the putatively schizophrenic experiences of self-disorder in a broader, comparative context; 2, evaluate hypotheses concerning core processes in schizophrenia; 3, orient investigation of possible pathogenetic pathways as well as psychotherapeutic interventions.     

What do We Know about Family Interventions for Psychosis at the Process Level? A Systematic Review

The evidence regarding effectiveness of family interventions for psychosis (FIP) is strong and consistent. However, there is a gap in the research on the process of these interventions, and little is known about their active ingredients. This review aims to identify the active ingredients of FIP. We conducted a systematic literature review, focusing on qualitative research, and analyzed 22 papers in total. We found a single study comprehensively exploring the process of FIP. All other studies focused on particular aspects of process‐related variables. The key elements of FIP seem to be the so‐called “common therapeutic factors”, followed by education about the illness and coping skills training. This review supports the value of a stepped model of intervention according to the needs of the families. However, the evidence reviewed also reveals a gap in the research findings based on the limited research available. FIP are complex, psychosocial interventions with multiple components, and more intensive, qualitative research is needed to establish linkages between process and outcome.     

The dreaming brain/mind, consciousness and psychosis

Several independent lines of research in neurobiology seem to support the phenomenologically-grounded view of the dreaming brain/mind as a useful model for psychosis. Hallucinatory phenomena and thought disorders found in psychosis share several peculiarities with dreaming, where internally generated, vivid sensorimotor imagery along with often heightened and incongruous emotion are paired with a decrease in ego functions which ultimately leads to a severe impairment in reality testing. Contemporary conceptualizations of severe mental disorders view psychosis as one psychopathological dimension that may be found across several diagnostic categories. Some experimental data have shown cognitive bizarreness to be equally elevated in dreams and in the waking cognition of acutely psychotic subjects and in patients treated with pro-dopaminergic drugs, independent of the underlying disorder. Further studies into the neurofunctional underpinnings of both conditions will help to clarify the use and validity of this model.     

How to integrate dreaming into a general theory of consciousness--a critical review of existing positions and suggestions for future research

In this paper, we address the different ways in which dream research can contribute to interdisciplinary consciousness research. As a second global state of consciousness aside from wakefulness, dreaming is an important contrast condition for theories of waking consciousness. However, programmatic suggestions for integrating dreaming into broader theories of consciousness, for instance by regarding dreams as a model system of standard or pathological wake states, have not yielded straightforward results. We review existing proposals for using dreaming as a model system, taking into account concerns about the concept of modeling and the adequacy and practical feasibility of dreaming as a model system. We conclude that existing modeling approaches are premature and rely on controversial background assumptions. Instead, we suggest that contrastive analysis of dreaming and wakefulness presents a more promising strategy for integrating dreaming into a broader research context and solving many of the problems involved in the modeling approach.