Gender-Moderated Dorsolateral Prefrontal Reductions in 22q11.2 Deletion Syndrome: Implications for Risk for Schizophrenia

To investigate the impact of the microdeletion on morphology of the prefrontal cortex in 22q11.2 Deletion Syndrome (22q11.2 DS), high-resolution, anatomic magnetic resonance imaging was performed on 19 children and adolescents with 22q11.2 DS (11 females, 8 males) and 18 unaffected controls (10 females, 8 males). Tissue volumes of the dorsolateral, dorsomedial, orbitolateral, and orbitomedial prefrontal cortex were measured. Tasks of executive function and working memory were administered to investigate the association between anatomy and function. Whole brain volume and frontal lobe tissue volume were preserved in girls but reduced in boys with 22q11.2 DS relative to age-matched controls. Dorsolateral prefrontal cortex (DLPFC) volumes were reduced in participants with 22q11.2 DS, although the gender-by-diagnosis effect found for frontal lobe was not as robust for DLPFC. DLPFC volumes were associated with performance on tasks of planning and emotional facial recognition. Longitudinal studies are needed to clarify whether gender differences in frontal lobe and DLPFC persist with development, and whether the volumes of the DLPFC are associated with eventual deterioration in adaptive/psychosocial function that may presage the onset of schizophrenia, for which individuals with 22q11.2 DS are at a disproportionately high risk.     

Frustration and disappointment

The paper describes research on children’s responses to failures of gratification. Although this has always been an important area of consideration in psychoanalytic thinking, arguments are put forward for the child’s actual feelings of disappointment being significant in ways that have yet to be fully realised theoretically and clinically within Kleinian object relations. Since Freud first used the term ‘frustration’, it has been applied in psychoanalysis as a means by which to describe in an undifferentiated way all those responses to failures of gratification that have an aggressive content. It will be argued that, in a context of the historical shift in thinking from drive to relational models, there is now perhaps scope to posit the existence instead of two discrete object relational positions towards such failures of aim – that frustrated responses can be differentiated in important structural and developmental ways from disappointed ones, by suggesting that the former are schizoid, whilst the latter are depressive in quality. To try and begin to test the hypothesis that there might be an object relational distinction between feelings of frustration and feelings of disappointment, selected process notes from two training cases became the subject of a combined piece of clinical and theoretical research. I will outline how this research was undertaken and present the findings that arose from the clinical part of it. With the use of a content analysis, a method for gathering interesting quantitative data about the children’s various responses to the failures of gratification was arrived at.     

Do Patients With Psychosis Experience Loss and Grief As a Result of Their Illness?

BACKGROUND: Depression and suicidality are frequently reported in patients with psychosis and schizophrenia, but the grief process that may be associated with this illness has not been systematically studied. In this study, we examined whether patients diagnosed with psychosis identify, grieve, and mourn losses engendered by the illness. METHOD: 24 patients diagnosed with psychosis in the past five years were surveyed to indicate whether their illness led to losses, and to describe their responses to the losses. Psychosis-related perceived losses were surveyed using three subscales of a loss and grief questionnaire (loss of self, self-care, and roles). Their relationship with beliefs about the illness, symptomatology, coping style, and self-efficacy and insight was studied. RESULTS: 23 (96%) patients named specific losses, and 16 patients (67%) reported feelings associated with grief and mourning. More than half reported loss of self-esteem at the onset of illness and only half saw themselves as having improved in the past month. Patients reported more loss within the past month than at the onset of illness. In the past month, patients with an intact sense of self experienced greater self-efficacy (r = .568, p < .004) while those with loss of self reported feelings of shame (r = ?.582, p < .003). Only patients with insight associated the onset of illness with loss. In the past month, most patients saw themselves as experiencing loss. DISCUSSION: The study results suggest that at some distance from diagnosis, patients still experience themselves as having much loss due to their illness. These unresolved feelings may indicate complicated mourning. Insight appears to be associated with the ability to look back at the onset of the illness and recognize that it engendered losses. Further study of the process of and barriers to grief and mourning is recommended. In clinical practice, the assessment of grief as a part of post-psychotic recovery could lead to providing more appropriate treatment and lead to a positive outcome.     

The cortisol awakening response in caregivers of schizophrenic offspring shows sensitivity to patient status

Abstract

Taking care of offspring during a prolonged period of time is probably one of the most stressful life experiences for parents. The present study compares the cortisol awakening response (CAR) in 38 long-term caregivers (mothers and fathers of schizophrenic relatives) with a control group of 32 non-caregivers. Factors such as general stress, caregiver burden, patient severity, and institutionalization were studied. Although a blunted CAR was observed in caregivers in comparison with controls, this difference was not significant. Among caregivers, the absence of institutionalization for the patient is associated with a lack of CAR in caregivers in comparison with caregivers of institutionally supported patients. General stress, caregiver burden, and patient severity themselves did not favor significant changes in CAR. CAR shows greater sensitivity to institutional support than patient severity and perceived stress. Further research is needed to explain the impact of these factors on health and the psychological factors involved.     

Childhood Abuse,Head Injuries,and Use of Medical Emergency Services in People with Severe Mental Illness

People with severe mental illness (SMI) report high rates of traumatic experiences. This study analyzes data collected from 183 people diagnosed with SMI on reports of childhood trauma, head injuries, and emergency room (ER) services. More than half the cohort (56.7%) reported 3 to 7 cooccurring categories of childhood abuse (CAB). People who reported 6 and 7 categories of CAB had a 5-fold risk of experiencing a head injury. If they have used the ER for reasons other than psychiatric illness they endorse more traumatic experiences in their childhood when compared to those who did not. People with SMI and cooccurring CAB experiences might be predisposed to a higher risk of head injuries and more frequent use of the ER.     

Queering Black Homophobia: Black Theology as a Sexual Discourse of Transformation

Abstract

This article explores black homophobia as a co-constitutive phenomenon which harbors the fear of the loss of a black archetypal identity that can be understood as (hetero)normative. Using a method of queering black homophobia from a hetero non-normative viewpoint, an exploration of the authenticity of a liberation viewpoint that is multivocal, multidimensional, and offering an interpretation that is inclusive of identities that trouble the waters of black hetero-patriarchal hegemony will be in question as it relates to the role of the Hamitic hypothesis and those interpretations that conflate evil, sexual perversion, and human degeneration within blackness.     

A community survey of psychological symptoms: evaluating evolutionary theories regarding shamanism and schizophrenia

Evolutionary theories regarding shamanism and schizophrenia provide hypotheses testable through analysis of survey data. A questionnaire, administered to a predominately African-American sample in North Carolina (N?=?965), surveyed schizotypal experience and other psychological symptoms, absorption and related psychological variables, childhood and adolescent difficulty, and incidence of unusual experiences (apparitions, paranormal dreams, waking ESP, out-of-body experience, near-death experience, sleep paralysis, UFOs, spiritual healing, and religious experiences). Study findings replicated Mirowsky's results regarding overlapping boundaries between psychiatric diagnoses. Findings also supported evolutionary hypotheses regarding correlations between schizotypal experiences, psychological variables related to shamanism, unusual experiences, and childhood/adolescent difficulty. Findings suggest use of religion-based cognitive behavioural therapy for distressed people reporting frequent unusual experiences.     

Parental object representations,attachment to God,and recovery among individuals with psychosis

This study explored the relationships between object representations of mother and father and recovery among outpatients with psychotic disorders, and examined the role of attachment to God in moderating those relationships. A total of 46 outpatients diagnosed with schizophrenia or schizoaffective disorder participated. Benevolent representations of mother and father were associated with recovery whereas punitive representations were negatively associated with recovery. Secure attachment to God amplified the association between benevolent representations of father and recovery. Secure attachment to God was found to buffer the relationship between mild-to-moderate punitive parental representations and recovery; however, this relationship was not evident for those with the most punitive parental representations. Directions for future research and clinical implications are discussed.     

When soft voices die: auditory verbal hallucinations and a four letter word (love)

Understandings of auditory verbal hallucinations (also referred to as “hearing voices”), and help for people distressed by them, are dominated by a biomedical framework. Yet, many people who have sought help for the distress and/or impairment caused by hearing voices express dissatisfaction with treatment solely within this framework, highlighting the need for a more rounded, biopsychosocial-spiritual approach. This paper examines the neglected role of a fundamental part of human experience, love, in the experience of hearing voices. First, we argue a lack of love is likely to play a causal role in voice-hearing experiences. Second, we demonstrate that a lack of love is central to the distress and dysfunction often caused by hearing voices. Finally, we show that love plays a core role in recovery. Given this centrality of love, we argue that an interdisciplinary approach to hearing voices involving the mind sciences and theology/religion may be fruitful. The relevance of this for psychotherapeutic interventions for people who hear voices is discussed.