Latent inhibition and context change in psychometrically defined schizotypy

The disruption of latent inhibition within the schizophrenia spectrum has often been interpreted either as a result of increased attentional distractibility (attentional account) or as a result of deficient interference of past associations (associative account). The aim of the present investigation was to test competing predictions, as derived from the above theoretical accounts. In a visual search paradigm of latent inhibition, accuracy was examined as a function of prior experience with the target, and psychometrically defined schizotypy. In Experiment 1 (N=60), no context change was introduced. In accord with past evidence, latent inhibition was found to be intact in low-, but disrupted in high-schizotypy scorers, a result predicted both by attentional and associative accounts. In Experiment 2 (N=60), a context change was introduced. As predicted by past evidence, latent inhibition was disrupted in low-schizotypy scorers. However, latent inhibition was found to be intact in high-schizotypy scorers, a finding accommodated by attentional, but not associative accounts. Theoretical implications and alternative interpretations are also considered.     

Psychotic functioning in adolescence: The perverse solution to survive

A psychotic breakdown in adolescence marks the emergence of a manifest aspect of a more complex process that has its origins in the patient's family pre‐history and in the patient's childhood story. This period of life is characterized by a sensorial explosion and adolescents will react differently according to the different resources they have at their disposal. Adolescents will attempt to create defensive solutions in order to face this decompensation on their own. In particular, polymorphously perverse behaviours can be utilized because of their specific characteristics in order to create a potent defence used to arrest a still more severe regression and at the same time providing the time necessary to safely navigate through a difficult and dangerous developmental phase. These solutions can be transitory or transform themselves into lasting defensive adaptations. These defensive modalities are very complex and articulated and can become fossilized in time, as, for example, in the case of a use of perverse defences against a breakdown. An analyst finding him/herself in these situations will find it difficult to differentiate in the diagnosis between a condition that is due to a perverse functioning used as a defence against decompensation, and a truly perverse structure that is beginning to emerge after puberty.     

Transference with the borderline client

This paper addresses the question of what is involved in psychodynamic counselling with borderline clients. The concept of borderline functioning or structure is explained and the technical difficulties of working in this area noted, especially in the establishment of a working alliance. The types of transference manifestations with borderline clients are then described, looking in particular at the emergence of a psychotic transference. Two case examples are given of working with borderline clients, where the transference was dominated by primitive elements, provoking powerful countertransference reactions in the counsellor. How both the client and the counsellor can be contained in the therapeutic work is then addressed. Finally, some implications of this discussion are drawn out for the training of psychodynamic counsellors, in order to equip them best for working with borderline clients. Three features of what a training should offer are identified: it should provide students with the opportunity for the exploration of the psychotic parts of their own personality; it should allow for and encourage the internalization of psychoanalysis itself as a sustaining internal object; and it should provide students with the experience of working with clients over sufficient time and at sufficient depth so they can learn about the timing and effectiveness of interventions in work with borderline clients.     

Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results

Cognitive behavior therapy (CBT) has been demonstrated in a number of randomized controlled trials to be efficacious as an adjunctive treatment for psychotic disorders. Emerging evidence suggests the usefulness of CBT interventions that incorporate acceptance/mindfulness-based approaches for this population. The current study extended previous research by Bach and Hayes (2002. The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139) using Acceptance and Commitment Therapy (ACT) in the treatment of psychosis. Psychiatric inpatients with psychotic symptoms were randomly assigned to enhanced treatment as usual (ETAU) or ETAU plus individual sessions of ACT. At discharge from the hospital, results suggested short-term advantages in the ACT group in affective symptoms, overall improvement, social impairment, and distress associated with hallucinations. In addition, more participants in the ACT condition reached clinically significant symptom improvement at discharge. Although 4-month rehospitalization rates were lower in the ACT group, these differences did not reach statistical significance. Decreases in the believability of hallucinations during treatment were observed only in the ACT condition, and change in believability was strongly associated with change in distress after controlling for change in the frequency of hallucinations. Results are interpreted as largely consistent with the findings of Bach and Hayes and warrant further investigations with larger samples.     

Fragmentation,persecution and primitive guilt

The clinical and theoretical approaches of Melanie Klein and her followers provide valuable direction in the psychoanalytic treatment of psychotic patients. This paper looks at Klein's work as well as the goals of psychoanalytic work. The clinical issues of primitive guilt and paranoia are discussed with regard to more primitive patients who experience internal fragmentation and psychic chaos. Finally, a case is explored in which a psychotic patient struggled with experiences of primitive guilt and intense persecutory phantasies.     

Gone but not forgotten: A new look at difficult cases

Many treatments never seem to get off the ground. They end almost as quickly as they begin. These are often treatments of borderline, narcissistic or psychotic patients. While it is easy to dismiss these cases as failed, or unanalysable, they are valuable to study. One such case is presented.     

Mediation of the stigma in the influence of negative symptomatology over recovery in psychosis

Background/Objective: The interest in recovery processes in psychotic disorders has boosted the necessity of knowledge about the factors that could influence in such recovery. Negative symptomatology and the stigma have been negatively linked to the recovery process in psychosis. The aim of this investigation is to improve the understanding of how the recovery process is affected by negative symptomatology based on the analysis of the mediating effects of the internalized stigma. Method: The sample was composed of 114 people that had experienced, at some point in their life, at least one clinically relevant psychotic episode. CAPE-42, STORI and ISMI were used for the evaluation. The macro PROCESS for SPSS was used. The indirect effect was calculated using 10.000 samples of bootstrap for the bootstrap confidence intervals (IC) corrected for bias. Results: The results show that the influence of negative symptomatology predicts the stigmatization of the person regarding his disorder. This predicts a negative influence in the recovery process of the psychosis. Conclusions: These results back the importance of adding the reduction of the stigma as a specific strategy to improve the recovery process in psychotic disorders.     

Familiar/interactive raters are not always best: The influence of sampling schedules and class of behavior

Retrospective rating scales are widely used for formal assessment of typical performance. Raters who are the most familiar/interactive with ratees are routinely recommended to maximize the quality of ratings. This caveat to use the most familiar/interactive raters fails to distinguish sampling parameters of the observations on which ratings are based that may be important to assessing different classes of behavior. We hypothesized that systematic observational schedules would be of greater importance to ratings of public events than familiarity/interaction, per se, while the caveat would hold for ratings of private events. We used the Psychotic Inpatient Profile (PIP), which provides separate factor scores for ratings of public and private events, to examine these hypotheses in a quasi-experimental study with adult inpatients of mental hospitals. A large multiinstitutional data set provided retrospective PIP ratings by two types of raters. The most familiar/interactive local clinical staff for each client completed the PIP after observing on an ad lib schedule, along with ongoing job duties. Unfamiliar, noninteractive raters completed the PIP for each client after observing on a systematic time-sampling schedule for purposes of coding an entirely different instrument. Data were selected so that each of 189 clients received PIP scores from four raters, reflecting functioning during the same time period based on day-shift observations by one rater of each type and evening-shift observations by one rater of each type. Analyses of variance, consistency/discriminability of ratings, and prediction of social-action outcomes all supported the hypotheses. We discuss alternative strategies that are better for assessing typical performance in most circumstances. We also provide recommendations for improving the adequacy of observations for those circumstances in which the standardized retrospective rating scale could be a cost-effective assessment strategy.This study was the basis of a master's thesis at the University of Houston by the senior author under the direction of the junior authors. Richard M. Rozelle served on the examination committee. This study was partially supported by grants to Gordon L. Paul from the National Institute of Mental Health, Public Health Service (MH-15353; MH-25464); the Illinois Department of Mental Health and Developmental Disabilities; the Joyce Foundation; the MacArthur Foundation; the Owsley Foundation; the Cullen Foundation; and the Center for Public Policy of the University of Houston.     

Church-based social interactions and psychotic experiences among Black Americans: findings from the National Survey of American Life

Religious attendance has generally been salutary for mental health, though recent evidence suggests that church attendance has no significant relation with psychotic experiences. This study will examine how various types of church-based social interactions might be related to psychotic experiences. We analysed data from the National Survey of American Life –a representative sample of Black Americans in the United States –and used multivariable logistic regression to examine associations between seven church-based social interaction variables and lifetime psychotic experiences. In separate models, church attendance, church member interaction, and closeness to church members were not significantly associated with psychotic experiences, while greater emotional support, negative social interactions, providing help to other church members and receiving help from fellow church members were associated with increased odds of reporting psychotic experiences. But in a fully adjusted model including all church-based social interaction variables, only negative church interactions and giving help to church members were significantly associated with psychotic experiences. Church-based social interactions did not protect against psychotic experiences, and in some cases increased risk. Future studies should explore why the deleterious aspects of social interactions prevail over the beneficial ones.