Therapeutic Factors Contributing to Change in Cognitive-Behavioral Group Therapy for Older Persons with Schizophrenia

The contributions of homework, therapy participation, cognitive insight, and skills acquisition to treatment outcomes in group CBT for schizophrenia were examined. Increased cognitive insight was associated with reduced positive, negative and total symptoms, but not improved psychosocial functioning. Greater participation was associated with increased cognitive insight, reduction in total and negative symptoms, and a trend was found for positive symptoms. Greater homework adherence was associated with greater skill acquisition, but skill acquisition was not significantly associated with change in any outcome. The therapeutic factors contributing to change in CBT for schizophrenia appear different for symptom and psychosocial functioning outcomes.     

Validation studies of the Paranoia Checklist (Portuguese version) in mixed sample of patients and healthy controls

Introduction

Paranoid ideation has been consistently found as a phenomenon presented across the population continuum, and a theme that most people find in their everyday thoughts.

Inside the experience of anorexia nervosa: A narrative thematic analysis

Aim: This study considers the question of whether inpatient admission for anorexia nervosa was a therapeutic experience for two women with chronic anorexia nervosa. The question of whether inpatient admission for anorexia nervosa can be therapeutic is not answerable through existing research evidence. Method: The women were interviewed about their experience of having anorexia, its impact on their lives and the treatment they received. The interviews involved learning about the women's experiences by listening to their stories rather than asking them direct questions about what has been therapeutic about their treatment. Analysis: Their narratives were used to develop understanding grounded in experience and were analysed using a narrative thematic analysis. Ideas, themes and connections were noted but not coded as found in some forms of thematic analysis. Discussion: Consideration is given to the therapeutic qualities of the treatments the women received and the place of therapeutic inpatient admission. The central theme of this research was ‘relationships’ which indicates the use of therapeutic approaches that emphasise the importance of the therapeutic relationship in the treatment of chronic anorexia nervosa. It is suggested that psychodynamic and attachment theories should be used to inform overall treatment models. Some important issues for service provision and areas for further research are identified.     

Deficits in the ability to recognize one's own affects and those of others: associations with neurocognition, symptoms and sexual trauma among persons with schizophrenia spectrum disorders

While many with schizophrenia experience deficits in metacognition it is unclear whether those deficits are related to other features of illness. To explore this issue, the current study classified participants with schizophrenia as possessing a deficit in both awareness of their own emotions and those of others (n = 30), aware of their own emotions but unaware of the emotions of others (n = 50) and aware of their own emotions and of other’s emotions (n = 17). Groups were compared on assessments of neurocognitive function, symptoms, and history of sexual trauma. ANCOVA controlling for education found that the group unaware of their own emotions and those of others demonstrated poorer verbal memory, processing speed, executive function, less emotional discomfort and higher levels of disorganization symptoms relative to the other groups. The group aware of their own emotions but not those of others had a significantly higher report of childhood sexual abuse.     

Executive function tests in early‐onset psychosis: which one to choose?

People with schizophrenia exhibit executive functioning deficits, an area well investigated in the adult onset schizophrenia (AOS) group, but far less so in early-onset schizophrenia (EOS). Since EOS in general seems to exhibit poorer cognitive functions and is clinically more compromised than AOS, choice of efficient and sensitive assessment measures is not necessarily the same within the two groups. The MATRICS Consensus Cognitive Battery was developed for adults when studying treatment effects and uses Mazes (Neuropsychological Assessment Battery [NAB]) to assess executive functioning. We tested 31 adolescents with schizophrenia spectrum disorders and 66 healthy controls in order to examine how Mazes compares to two other commonly used tests to measure executive functioning, D-KEFS Color Word Interference Test (Stroop) and the Wisconsin Card Sorting Test (WCST). Significant discriminating power was found for all three measures. Patients performed 0.8-1.5 SD below controls with Stroop as the most sensitive measure, followed by Mazes and WCST. Mazes was selected by the MATRICS to assess treatment effects in AOS and is shown to be able. We find the instrument also able to separate adolescent patients from controls and thus, it appears a sensible choice in clinical settings. If a more elaborated neuropsychological evaluation of the executive functioning domain is needed, Stroop should be considered a complementary test.     

Facial affect recognition deficits: A potential contributor to aggression in psychotic illness

The current literature suggests a relationship between psychosis and the likelihood of engaging in aggressive behavior, though the factors involved are unclear. In this paper we use a social information processing framework to consider mediators of aggressive behavior in psychosis, especially facial affect recognition (FAR) deficits. The theoretical underpinnings of aggressive behavior are explored using the General Aggression Model (GAM) and FAR deficits are posited as a possible contributor to increased aggression in psychosis. Current research investigating the relationship between FAR, psychosis, and aggression is critically examined, and the role of potential confounding variables including positive symptoms, psychopathic personality traits, childhood trauma, and substance use briefly explored. In conclusion, we argue that socioemotional processing deficits, such as impaired FAR, are a fruitful area for research aimed at understanding, and hence reducing the risk of violence in psychosis.     

The Great Mother and the Terrible Mother: mimesis,alterity and attachment in adolescence

This paper discusses attachment, the longing for familiarity and sameness (mimesis), the search for difference and separateness (alterity) and the problem with the Other¹ seen through the lens ofthe individuation process in adolescence. These are explored with reference to relational aspects and Levinas and Girard's divergent views of the Other. The relational space, which in Phillip Bromberg's (2003) words is ‘uniquely relational, but still uniquely individual’ and in which analyst and patient ‘stand together in the space between realities’, might under exceptional circumstances be transformed into ‘a twilight space where the impossible becomes possible’ (p. 573). I will sketch a developmental trajectory starting from primitive states, in which the presence of the Other,as a separate entity cannot be tolerated and where the patient strives for total mimesis. Should the analyst prematurely shatter this illusion, she becomes an alien ‘Other’; a wolf in sheep's clothing. I trace the current psychoanalytic paradigm shift to an emphasis on the co‐creation of meaning in the interpersonal space and explore what alterity consists of and how much of the other's unknowability can be tolerated and respected without a translation into one's own idiom. The clinical vignettes illustrate aspects of therapy which normally lie outside the analytical remit and are culled from an inpatient setting and private practice.     

Short- and Long-Term Effects of Inpatient Cognitive-Behavioral Treatment of Adolescents With Anxious-Depressed School Absenteeism: A Within-Subject Comparison of Changes

The effects of inpatient treatment, including manual-guided cognitive-behavioral treatment (CBT), were examined for 36 adolescents (12–18 years) with chronic school absenteeism and mental health problems. Using a within-subject control group design, no changes were noted during the untreated waiting period, whereas there was a strong, statistically significant reduction in school absence rates and mental health problems from the start to the end of inpatient treatment. At discharge, 88.9% of adolescents attended school regularly or were employed (86.1 and 63.9% at 2- and 9-months follow-up, respectively). Self- and parent-reported mental health problems were significantly reduced during treatment and remained stable during follow-up.     

Editorial

No abstract available for this article.     

The Relationship between Personality Disorder Features and Symptom Improvement at an Inpatient Treatment Program for Posttraumatic Stress Disorder

This study examined the association between personality disorder (PD) features and symptom improvement among adult survivors of childhood trauma in an inpatient program for posttraumatic stress disorder (PTSD). Participants completed questionnaires at admission, discharge, and six months following discharge. Multiple regression analyses were used to assess the combined effects of personality features on symptom improvement. Results indicated that improvement in trauma-related symptoms was not related to PD features. By contrast, the PD features were associated with change in other Axis I symptoms often comorbid with PTSD. Overall, results suggested that PD features do not impede improvement in trauma-related symptoms; however, specific accommodations might be needed to address comorbid disorders among individuals with PTSD.