Cognitive Insight in Inpatients with Psychotic, Bipolar, and Major Depressive Disorders

The Beck Cognitive Insight Scale (BCIS; Beck, Baruch, Balter, Steer, & Warman, 2004) was administered to 42 (28%) inpatients with psychotic disorders, 52 (35%) with a bipolar disorder, and 56 (37%) with a major depressive disorder (MDD). The hypotheses were (a) that the mean level of cognitive insight in a psychotic or a bipolar disorder is lower than that in a MDD, (b) that the mean levels of cognitive insight in psychotic and bipolar disorders were comparable, and (c) that the mean BCIS index score for a bipolar disorder in which the most recent episode had been mania is lower than the mean BCIS index score for a bipolar disorder in which the most recent episode had been mixed or depressed. All three hypotheses were supported. The results were discussed as supporting cognitive insight as a psychological construct that varies predictably according to the nature of a psychiatric disorder.     

Community Implementation Successes and Challenges of a Cognitive-Behavior Therapy Group for Individuals with a First Episode of Psychosis

CBT for psychosis has recently been called a best practice, suggesting that studies have demonstrated its efficacy with many populations. Community settings are encouraged to implement best practices such as CBT yet many factors can make the implementation of CBT challenging. Issues such as clinician resistance, setting, as well as client variables (refusal, denial of symptoms, etc.) come into play. Examples of successes and challenges of a community based study of CBT groups for first episodes will be described. The strategies used to overcome these challenges and the successes of the program will be presented.     

Patient preferences for medicine administration for acute agitation: results from an internet-based survey of patients diagnosed with bipolar disorder or schizophrenia in two Nordic countries

The objective was to elicit patient preferences for medicine administration method in the management of acute agitation episodes among patients diagnosed with bipolar disorder or schizophrenia. The patients’ experiences of acute agitation episodes and their management of episodes were also explored. Data were collected via an anonymous, internet-based survey of residents in Denmark or Sweden with schizophrenia or bipolar disorder (October 2014 to December 2014). Inclusion criteria were having a diagnosis of schizophrenia or bipolar disorder, and being above 18 years of age. The questionnaire included questions about preferences for medication attributes, experiences with pharmacological treatment for agitation and involvement in treatment plans. A total of 237 diagnosed patients (61 with schizophrenia; 176 with bipolar disorder) completed the questionnaire. Agitation episodes were experienced by 90% of the respondents. In total, 83% of the respondents reported having received treatment with tablets. When patients were presented with the attributes of an inhalation method, respondents stated that the fast onset of action, low risk of adverse reactions and least invasive form of drug delivery were positive attributes of treatment with inhalation. Inhalation is a new delivery route for treatment of acute agitation in patients diagnosed with bipolar disorder or schizophrenia. Inhalation is the preferred treatment method for acute agitation among Danish and Swedish patients with bipolar disorder or schizophrenia.     

Recognizing Trauma and Posttraumatic Stress Disorder Symptoms in Individuals With Psychotic Disorders

The majority of individuals diagnosed with a psychotic episode also meet symptom criteria for posttraumatic stress disorder (PTSD; Mueser, Lu, Rosenberg, & Wolfe, 2010 ). Unfortunately, trauma from both previous life events and the experiences of a psychotic episode as well as PTSD symptoms are rarely recognized in this population. Steps to assessing trauma history and PTSD symptoms and initiating treatment in a client diagnosed with a psychotic disorder are highlighted.     

Brief functional analysis and treatment of bizarre vocalizations in an adult with schizophrenia

Variables responsible for the maintenance of bizarre vocalizations emitted by an adult diagnosed with schizophrenia were examined via a brief functional analysis, and results suggested that the behavior was maintained by attention. A treatment consisting of extinction and differential reinforcement of appropriate vocalizations was effective in reducing bizarre vocalizations and increasing appropriate vocalizations. The use of functional analysis methodology to examine variables that maintain problem behavior in this population is discussed.     

Kainic acid lesions disrupt fear-mediated memory processing

Previous research has shown that hippocampal lesions impair the expression of fear conditioning. This fear conditioning deficit may be due to memory impairment or a reduction in fear in lesioned animals. To address these possibilities, the authors examined unconditioned and conditioned fear in male Sprague-Dawley rats that had received intracerebroventricular (ICV) infusions of kainic acid (KA) 30 days prior to testing. Animals that had received bilateral ICV infusions of KA (1.0 microl of 0.8 mg/ml solution per side) exhibited cell loss that was primarily confined to the CA3 region of the dorsal hippocampus. Kainic acid lesions impaired contextual and cued fear conditioning but did not affect unconditioned fear in a light:dark test of anxiety. Moreover, animals with KA lesions did not habituate to the light:dark apparatus when tested over a 3-day period. These data suggest that decreases in fear conditioning produced by hippocampal lesions reflect a memory deficit and not a lack of fear.     

Narrative Understanding in Acute Psychosis

Hermeneutical premises are adequate in understanding the psychotic patient. It is more important to hear and try to understand the patient's story told by the latter as an equal partner in conversation than understand events through stories in which the meanings are already determined. Understanding is dependent on the unique way in which the feelings, thoughts, and actions of the patient are connected with those of the ward staff, i.e., mutual knowledge. In this way understanding conforms to the preunderstanding of the interpreter as well as adequately captures the intentions of its originator. These are the preconditions for the integration of the need-adapted approach to the treatment of schizophrenia.     

Reactions to ambiguous stimuli among paranoid personalities

The psychological literature on paranoia and paranoid schizophrenia is extensive, particularly in the area of perceptual and cognitive processing. However, there has been a relative neglect of paranoid personality. The present study investigates whether paranoid personalities differed from controls in their responses to ambiguous or incomplete stimuli. Paranoid personalities (PP), other personality controls (OP), and normal subjects (NR) were exposed to blurred pictures of zoo animals which became progressively clearer. Subjects were asked to identify the content of such pictures from a list provided and to rate their confidence in their respective identifications. The PPs were unique in suspecting that correct answers were not provided by the experimenters. The confidence levels of the PPs also decreased significantly during the course of the experiment, whereas the OP and NR subjects' levels did not. The PP group made significantly earlier attempts at identifying the ambiguous slides and were significantly more accurate in doing so compared to the NR group. Neither group differed significantly from the OR controls on these two measures. The significance of the results are discussed.     

Disconfirmatory feedback in families of schizophrenics

A new approach to the study of family communication and psychopathology, in particular schizophrenia, using Saugstad's theory about use of language as its point of departure is presented. Conflicts between family members were observed and measured using a new unrevealed difference technique, the Colour Conflict Method (CCM). Communication was analysed in terms of continuous feedback processes, using the new computerized method, Confirmation-Disconfirmation Coding System (CONDIS). Feedback mechanisms in the internal communication of families of schizophrenics, normals, and non-schizophrenic pathological controls (n = 21) are described. The findings show that families of schizophrenics lack the ability to adapt their communication to changing situational requirements. When conflicts were introduced, families of schizophrenics-in contrast to non-schizophrenics within the extended schizophrenia spectrum and normals-increased their frequency of disconfirmatory feedback reactions instead of expressing disagreements openly. This was due to active disqualifications occurring between the parents and from the parents towards their schizophrenic offspring, who reacted with incomprehensible egocentric communication acts.     

What the Problem May Be With Family Intervention … and With Dissemination More Generally: A Commentary

While the two decades since the study by Kavanagh et al. (1993) has given additional insights into effective dissemination of family interventions, the accompanying papers show that progress remains limited. The effectiveness trial that triggered this series of papers offers a cautionary tale. Despite management support, 30–35 hr of workshop training and training of local supervisors who could act as champions, use of the full intervention was limited. In part, this seemed due to the demanding nature of the intervention and its incompatibility with practitioners' roles, in part, to limitations in the training, among other factors. While the accompanying papers note these and other barriers to dissemination, they miss a more disturbing finding in the original paper: Practitioners said they were using several aspects in routine care, despite being unable to accurately describe what they were. This finding highlights the risks in taking practitioners' reports of their practice in files or supervision sessions at face value and potentially has implications for reports of other clinical work. The fidelity of disseminated treatments can only be assured by audits of practice, accompanied by affirming but also corrective feedback.