Showing papers in "Journal of Nervous and Mental Disease in 2003"
TL;DR: Outcomes strongly favored the experimental groups in terms of the percentage of participants who worked at any point during the studies, and this effect size may be a useful benchmark for future trials.
Abstract: Although most individuals with schizophrenia are unemployed, plentiful evidence suggests that work rehabilitation is effective for this population. Yet, there have been only 11 published randomized controlled trials of work rehabilitation interventions for people with severe mental illness. We review these 11 studies, 9 of which were trials examining Individual Placement and Support (IPS) or supported employment (SE) interventions. Outcomes strongly favored the experimental groups in terms of the percentage of participants who worked at any point during the studies (weighted mean effect size = 0.66). In the 5 investigations comparing IPS/SE to conventional vocational rehabilitation services, 51% of the participants receiving IPS/SE worked competitively, versus 18% of those in the comparison groups (weighted mean effect size = 0.79). This effect size may be a useful benchmark for future trials. Further investigations should examine individual differences as predictors of response, to identify modifiable versus nonmodifiable factors that yield better outcomes.
280 citations
TL;DR: Analysis of data from two nationwide epidemiologic studies suggested that 50% to 60% of people who would benefit from treatment do not seek it, but subsequent analyses have shown that respondents with psychiatric diagnoses were more likely to avoid treatment.
Abstract: For the past 40 years, researchers have attempted t o explain why some people with mental illness seek services while others do not. R esearchers have hypothesized that the negative effects of stigmatizing attitudes may diss uade people from seeking care because they do not want to suffer the corresponding label of “mental patient.” Fairly compelling literature shows that people who may benefit from m ental health services do not seek them. Research from two nationwide epidemiologic st udies suggested that 50% to 60% of people who would benefit from treatment do not s eek it (Kessler et al., 2001 ;Regier et al., 1993). Subsequent analyses of these data have shown tha t respondents with psychiatric diagnoses were more likely to avoid ser vic s if they were unreceptive to treatment (e.g., agreeing that people should not se ek care if they have a mental or emotional problem) or believed that family members and others would have a negative reaction to these services ( Leaf et al., 1986, 1987 ;Kessler et al., 2001 ).
269 citations
TL;DR: Results from multivariate logistic regression indicated that job experience and confrontive coping were significant predictors of psychiatric morbidity, while job experience, distancing, escape‐avoidance, and positive reappraisal were significant Predictors of posttraumatic morbidity.
Abstract: Disaster workers are at high risk for developing psychiatric morbidity. This study examined the prevalence rates of psychiatric and posttraumatic distress and the relationship between psychiatric and posttraumatic morbidity and coping strategies among rescue workers following an earthquake in Taiwan on September 21, 1999. Eighty-four male firefighters who had been exposed to earthquake rescue work were assessed 5 months after the event. The Chinese Health Questionnaire (CHQ), the Impact of Event Scale (IES), and the Ways of Coping Questionnaire (WCQ) were used to assess psychiatric morbidity, posttraumatic morbidity, and coping strategies. The observed prevalence rates were 16.7% and 21.4% for general psychiatric morbidity and posttraumatic morbidity, respectively. Results from multivariate logistic regression indicated that job experience and confrontive coping were significant predictors of psychiatric morbidity, while job experience, distancing, escape-avoidance, and positive reappraisal were significant predictors of posttraumatic morbidity. Rescue workers with longer job experience were at the highest risk for developing psychiatric and posttraumatic distress.
154 citations
TL;DR: Analysis of pretreatment and 9-month follow-up data for 134 Australian Vietnam veterans who attended a treatment program for combat-related PTSD identified anger, alcohol, and depression as significant predictors of symptom change over time, independent of the effect of initial PTSD severity.
Abstract: Posttraumatic stress disorder (PTSD) is a difficult condition to treat, and existing studies show considerable variability in outcome. Investigations of factors that influence outcome have the potential to inform alternate treatment approaches to maximize benefits gained from interventions for the disorder. Because PTSD is commonly associated with comorbidity, it is important to investigate the influence of comorbidity on symptom change after treatment. This article examines pretreatment and 9-month follow-up data for 134 Australian Vietnam veterans who attended a treatment program for combat-related PTSD. A series of analyses were conducted to investigate the influence of the comorbid factors of anxiety, depression, anger, and alcohol use on PTSD symptom change after treatment. Analyses identified anger, alcohol, and depression as significant predictors of symptom change over time, independent of the effect of initial PTSD severity. Further analyses indicated that anger at intake was the most potent predictor of symptom change. Further investigations of anger as an influence on symptom change after treatment of combat-related PTSD is recommended.
154 citations
TL;DR: Responsibility magnitude varies and has an important effect on antidepressant clinical trials, illustrating the need for a placebo arm to determine if the trial was sensitive to treatment differences and highlighting the dangers of cross-study comparisons.
Abstract: Placebo response magnitude is suspected to affect the outcome of antidepressant clinical trials. To evaluate this, 52 randomized, double-blind, placebo-controlled clinical trials obtained from the FDA were examined to correlate placebo response magnitude with trial outcome. The magnitude of symptom reduction, percentage mean change from baseline in the Hamilton Depression Rating Scale (HAM-D), was assessed for patients assigned to placebo or an antidepressant. Correlation coefficients between symptom reduction with placebo and antidepressants and between symptom reduction with placebo and magnitude of advantage of antidepressants over placebo were assessed. A statistically significant positive correlation was seen between placebo and antidepressant response magnitude (r =.40, p 30% mean change from baseline) showed statistical superiority over placebo compared with 74.2% in trials with a low placebo response (< or =30). Response magnitude varies and has an important effect on antidepressant clinical trials, illustrating the need for a placebo arm to determine if the trial was sensitive to treatment differences and highlighting the dangers of cross-study comparisons.
152 citations
TL;DR: The present findings suggest that paranoia is a common human experience, and are consistent with the idea of continuity between normal and abnormal experience.
Abstract: The present study examined the incidence of paranoid ideation in a nonclinical population. A sample of 324 college students completed a questionnaire assessing their personal experiences of paranoia, with an emphasis on the cognitive, behavioral, and affective components of their experience. They also completed a general measure of paranoia in nonclinical samples, the Fenigstein and Vanable Paranoia Scale, and the Rosenberg Self-Esteem Scale. A total of 153 participants reported an experience of paranoia, which included a clear statement of planned intention to harm. This group scored significantly higher on the Paranoia Scale than those who reported no experience of paranoia. Furthermore, greater levels of paranoid ideation were associated with lower self-esteem. The present findings suggest that paranoia is a common human experience, and are consistent with the idea of continuity between normal and abnormal experience.
151 citations
TL;DR: The findings suggest that while attention is more important for initial success, verbal memory becomes more important in sustained improvement for sustained improvement in work performance.
Abstract: Studies have shown that cognitive functioning may limit the rate, tenure, and type of work performed by people with schizophrenia. The present study tested the hypothesis that cognitive abilities needed for initial improvement in work performance would differ from those needed in later vocational development. Ninety-six outpatients with schizophrenia or schizoaffective disorder who participated in a work rehabilitation program were administered neuropsychological testing at intake. Their work performance was evaluated biweekly for 26 weeks. Cognitive test variables were entered into regressions predicting the slope of individual performance curves from weeks 1 to 13 and 13 to 26. Neuropsychological variables accounted for 28% of the variance in slope during the initial period. The strongest predictor was a Continuous Performance Task variable that measures inattentiveness. Other important variables were measures of idiosyncratic thinking, cognitive flexibility, and verbal memory. Neuropsychological variables accounted for 19% of the variance in the slope during the final period. The strongest predictor was verbal learning, while measures of cognitive impulsivity and psychomotor functioning were also significant contributors. There was no relationship between work performance and symptoms for weeks 1 to 13 or 13 to 26. These findings suggest that while attention is more important for initial success, verbal memory becomes more important for sustained improvement. Remediating or accommodating such deficits in a time-sensitive fashion may be a necessary feature for successful rehabilitation.
148 citations
TL;DR: The incidence of posttraumatic stress disorder (PTSD) and depression in 586 earthquake survivors living in prefabricated housing sites a mean of 20 months after the 1999 earthquake in Turkey suggests that catastrophic earthquakes have long-term psychological consequences, particularly for survivors with high levels of trauma exposure.
Abstract: This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 586 earthquake survivors living in prefabricated housing sites a mean of 20 months after the 1999 earthquake in Turkey. The estimated rates of PTSD and major depression were 39% and 18%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, older age, participation in rescue work, having been trapped under rubble, and personal history of psychiatric illness. More severe depression symptoms related to older age, loss of close ones, single marital status, past psychiatric illness, previous trauma experience, female gender, and family history of psychiatric illness. These findings suggest that catastrophic earthquakes have long-term psychological consequences, particularly for survivors with high levels of trauma exposure. These findings lend further support to the need for long-term mental health care policies for earthquake survivors. Outreach service delivery programs are needed to access non-treatment-seeking survivors with chronic PTSD.
147 citations
TL;DR: The study provides direct evidence that individuals attribute mental states to virtual reality characters and indicates that feelings of interpersonal vulnerability and anxiety may directly contribute to the development of persecutory ideation in response to essentially neutral contexts.
Abstract: The use of virtual reality permits individuals' reactions to standard controlled environments to be studied. It may therefore provide a means for understanding the interpretations of experience relevant to clinical disorders. The use of this technology for understanding persecutory ideation has not been investigated. A pilot study was undertaken to examine whether individuals have persecutory thoughts about virtual reality characters under controlled conditions and if there are factors that predict the occurrence of such thoughts.Twenty-four nonclinical participants entered a neutral virtual environment that contained computer-generated people. The participants completed dimensional assessments of items related to psychiatric symptoms and their thoughts about the virtual characters. Positive views about the virtual characters were common. However, a number of participants had ideas of reference and ideas of persecution about the virtual characters. Individuals who had persecutory thoughts about the virtual characters had significantly higher levels of interpersonal sensitivity and anxiety. The study provides direct evidence that individuals attribute mental states to virtual reality characters. Important for the study of clinical phenomena, some individuals have thoughts of a persecutory nature about virtual characters. Additionally, the findings indicate that feelings of interpersonal vulnerability and anxiety may directly contribute to the development of persecutory ideation in response to essentially neutral contexts. Virtual reality may prove to be a valuable methodology for developing an understanding of persecutory ideation.
139 citations
TL;DR: Soteria treatment resulted in better 2-year outcomes for patients with newly diagnosed schizophrenia spectrum psychoses, particularly for completing subjects and for those with schizophrenia.
Abstract: The Soteria project (1971–1983) compared residential treatment in the community and minimal use of antipsychotic medication with “usual” hospital treatment for patients with early episode schizophrenia spectrum psychosis. Newly diagnosed DSM-II schizophrenia subjects were assigned consecutively (1971 to 1976, N = 79) or randomly (1976 to 1979, N = 100) to the hospital or Soteria and followed for 2 years. Admission diagnoses were subsequently converted to DSM-IV schizophrenia and schizophreniform disorder. Multivariate analyses evaluated hypotheses of equal or better outcomes in Soteria on eight individual outcome measures and a composite outcome scale in three ways: for endpoint subjects (N = 160), for completing subjects (N = 129), and for completing subjects corrected for differential attrition (N = 129). Endpoint subjects exhibited small to medium effect size trends favoring experimental treatment. Completing subjects had significantly better composite outcomes of a medium effect size at Soteria (+.47 SD, p = .03). Completing subjects with schizophrenia exhibited a large effect size benefit with Soteria treatment (+.81 SD, p = .02), particularly in domains of psychopathology, work, and social functioning. Soteria treatment resulted in better 2-year outcomes for patients with newly diagnosed schizophrenia spectrum psychoses, particularly for completing subjects and for those with schizophrenia. In addition, only 58% of Soteria subjects received antipsychotic medications during the follow-up period, and only 19% were continuously maintained on antipsychotic medications.
131 citations
TL;DR: Preliminary evidence that multi-family support and education groups are a feasible and possibly beneficial intervention for newly resettled refugees and indicates the need for further studies is provided.
Abstract: The object of this study was to describe a feasibility study of the Tea and Families Education and Support (TAFES) intervention used in a group of newly resettled adult refugees from Kosova. The subjects were 86 newly resettled Kosovar refugees in Chicago who gave informed consent to participate in an investigation of the TAFES intervention. All subjects received family home visits, and most participated in the TAFES multi-family groups. The instruments were administered to adult participants before and 3 months after the intervention. The TAFES program had contact with 61 Kosovar refugee families, of which 42 families (69%) engaged in TAFES groups, including families with educated and working members. Several characteristics were associated with engaging in TAFES groups and included lower monthly family income and higher age of the first child. The uncontrolled postintervention assessments demonstrated increases in social support and psychiatric service use associated with engagement in the TAFES group. Participants also showed time changes in scale scores assessing trauma mental health knowledge, trauma mental health attitudes, and family hardiness. This study provides preliminary evidence that multi-family support and education groups are a feasible and possibly beneficial intervention for newly resettled refugees and indicates the need for further studies.
TL;DR: Evidence on a) the magnitude of association between PTSD and psychosis, b) the causal mechanisms implicated, and c) treatment considerations relevant to this association are reviewed are reviewed.
Abstract: Several recent studies have provided direct evidence for the link between posttraumatic stress disorder (PTSD) and psychosis. Patients with psychotic disorders are known to be at a higher risk of traumatization and PTSD. Additionally, preclinical and clinical data suggest that the effects of trauma exposure on neural networks may provide a common diathesis for disorders like PTSD and schizophrenia. This article reviews evidence on a) the magnitude of association between PTSD and psychosis, b) the causal mechanisms implicated, and c) treatment considerations relevant to this association. A comprehensive MEDLINE search was conducted, and articles pertinent to epidemiological, clinical, and treatment aspects of comorbid PTSD and psychosis were identified. High rates of PTSD characterize patients with severe mental illness. Psychotic phenomena may also be a relatively common manifestation in patients with chronic PTSD. However, in clinical settings, the diagnosis is often missed, and few systematic guidelines exist for the identification and treatment of these comorbidities. Future neurobiological and treatment studies may be useful in better informing the clinical management of these subgroups.
TL;DR: In this population, trauma and PTSD were highly prevalent and associated with significant unidentified morbidity and comorbidity and psychotropic medication was prescribed for only 1% of participants.
Abstract: Despite increased awareness of the prevalence and morbidity of psychiatric illnesses, relatively few studies have been undertaken in primary care settings in the African context. The authors determined the prevalence of trauma exposure and posttraumatic stress disorder (PTSD) in a South African township primary health care clinic and assessed associated demographic factors, comorbidity, service use, service satisfaction, and quality of life. Subjects were directly interviewed using translated, standardized instruments to assess variables described. Retrospective chart analysis assessed clinician case identification and psychotropic drug-prescribing habits. Of the 201 participants, 94% reported exposure to traumatic events (mean, 3.8). Trauma was associated with single status (p =.01), and PTSD was associated with poverty and single status (p =.04). Both sexes were equally likely to develop PTSD. PTSD (current; 19.9%), depression (37%), and somatization disorder (18.4%) were the most common diagnoses. Comorbidity with PTSD was high and included depression (75%, p <.01), somatization (35%, p <.01), and panic disorder (25%, p <.01). Levels of functional impairment were higher for subjects with PTSD, depression, and somatization than for those without (p <.05). PTSD comorbid with depression compounded impairment (p =.04). Levels of trauma, PTSD, and depression did not increase service use or dissatisfaction with services. Clinicians did not identify trauma (0%) or psychopathology (0%), and psychotropic medication was prescribed for only 1% of participants. In this population, trauma and PTSD were highly prevalent and associated with significant unidentified morbidity and comorbidity. Patients remain untreated for years in the current system of primary care consultations.
TL;DR: The role of attitudes regarding the effectiveness of and potential problems associated with psychiatric medications on Americans’ willingness to use them is explored and willingness to use is influenced by these attitudes and other factors, including health status and past use of mental health treatments.
Abstract: Despite recent advances in treatment, many Americans decline to take prescribed psychiatric medication. This study explores the role of attitudes regarding the effectiveness of and potential problems associated with psychiatric medications on Americans' willingness to use them. Face-to-face interviews of a US household population sample were done with 1387 volunteers. The 1998 General Social Survey's (response rate, 76.4%) included questions about efficacy, problems, and potential use. Most Americans agree that psychiatric medications are effective, and fewer than half had concerns regarding potential problems. However, the majority of respondents would not be willing to take them. Willingness to use is influenced by these attitudes and other factors, including health status and past use of mental health treatments. Although Americans perceive psychiatric medications to be effective, and this influences their willingness to take them, many still are not willing to take them.
TL;DR: All the tested instruments were shown to be reliable, and proxy respondents were generally good judges of targets’ suicidal intention, social support, depression, life events, personality traits, and mental disorders.
Abstract: This study examined the reliability and validity of the instruments as used in the psychological autopsy method in China. With data from 130 informants on 66 completed suicides and 130 informants on 66 normal community controls and 66 controls themselves, the validity was examined by comparing the responses of informants and the responses (gold standards) of the target participants in the control group. All the tested instruments were shown to be reliable, and proxy respondents were generally good judges of targets' suicidal intention, social support, depression, life events, personality traits, and mental disorders. Additionally, interrater reliabilities of the five interviewers were very good on selected scales. This study has laid a partial foundation for future psychological autopsy projects to be held in Chinese culture.
TL;DR: *Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland; and †Department of Mental Health and Substance Dependence, World Health Organization, Geneva, Switzerland.
Abstract: *Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland; and †Department of Mental Health and Substance Dependence, World Health Organization, Geneva, Switzerland. Reprints: Shekhar Saxena, MD, Department of Mental Health and Substance Dependence, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland. E-mail: saxenas@who.int Copyright © 2003 by Lippincott Williams & Wilkins DOI: 10.1097/01.nmd.0000087188.96516.a3
TL;DR: It is demonstrated that robust statistical and clinically significant improvement can occur in a naturalistic/hybrid model of outpatient STPP for depression.
Abstract: This study investigates the effectiveness of short-term psychodynamic psychotherapy (STPP) for depression in a naturalistic setting utilizing a hybrid effectiveness/efficacy treatment research model. Twenty-one patients were assessed pre- and post-treatment through clinician ratings and patient self-report on scales representing specific DSM-IV depressive, global symptomatology, relational, social, and occupational functioning. Treatment credibility, fidelity, and satisfaction were examined, all of which were found to be high. All areas of functioning assessed exhibited significant and positive changes. These adaptive changes in functioning demonstrated large statistical effects. Likewise, changes in depressive symptoms evaluated at the patient level utilizing clinical significance methodology were found to be high. A significant direct process/outcome link between STPP therapist techniques and changes in depressive symptoms was observed. Alternative treatment interventions within STPP were evaluated in relation to subsequent improvements in depression and were found to be nonsignificant. The present results demonstrate that robust statistical and clinically significant improvement can occur in a naturalistic/hybrid model of outpatient STPP for depression.
TL;DR: The results indicate that both men and especially women with SPMI had a higher prevalence of obesity than the general population; this portends substantial health implications.
Abstract: Individuals with severe and persistent mental illness (SPMI) have a preponderance of weight problems, possibly even greater than the obesity epidemic in the general population. Although atypical antipsychotics cause weight gain, their contribution to obesity has not been characterized in a community setting where individuals may take multiple psychotropics associated with weight gain. Using survey information including measured height and weight from a random sample of Maryland Medicaid recipients with SPMI, we compared obesity prevalence to the National Health and Nutrition Examination Survey (NHANES III) sample and a Maryland sample (Behavioral Risk Factor Surveillance System) of the general population adjusted to SPMI demographic characteristics. We investigated correlates of obesity in the SPMI sample. The results indicate that both men and especially women with SPMI had a higher prevalence of obesity than the general population; this portends substantial health implications. A fourfold association between atypical antipsychotics and prevalent obesity was found in men but not in women; further work should clarify mechanisms of obesity in the SPMI.
TL;DR: Changes in stress process-related factors are stronger predictors of fluctuations in QOL domains than changes in illness symptoms and should be considered when evaluating life satisfaction.
Abstract: The author sought to determine domain-specific quality of life (QOL) changes over time and to identify predictors of change in life satisfaction among schizophrenia patients. He assessed 148 schizophrenia inpatients at admission and 16 months later. Multiple regression analysis identified predictors of domain-specific changes in QOL from changes in psychopathology, emotional distress, side effects, insight, and stress process-related factors ratings. On the group level, satisfaction with subjective feelings and leisure activities improved significantly during the follow-up period. Individual changes in specific QOL domains are influenced by different patterns of predictors that accounted for 12% to 36% of variance. Emotional distress, paranoid symptoms, side effects, and insight inversely associated with variability of scores in domain-specific QOL. Changes in self-efficacy, self-esteem, and support from others were positively correlated to improvement in QOL domain ratings. Schizophrenia patients may experience improvement in specific QOL domains. Changes in stress process-related factors are stronger predictors of fluctuations in QOL domains than changes in illness symptoms and should be considered when evaluating life satisfaction.
TL;DR: Ethnographic trust and rapport-building activities among investigators, field staff, and immigrant communities made it possible to obtain the sample and gather sensitive data, and maintaining a culture of trust was crucial in recovering from damaging environmental events that threatened data collection.
Abstract: We evaluated sampling strategies and trust-building activities in a large multiphase epidemiologic study of torture prevalence in populations that were difficult to locate and enroll. Refugee groups under study were Somalis from Somalia and Oromos from Ethiopia who were living in Minneapolis and St. Paul, Minnesota, in 1999-2002. Without a complete sampling frame from which to randomly recruit participants, we employed purposive sampling methods. Through comparative and statistical analyses, we found no apparent differences between our sample and the underlying population and discovered no effects of recruiting methods on study outcomes, suggesting that the sample could be analyzed with confidence. Ethnographic trust and rapport-building activities among investigators, field staff, and immigrant communities made it possible to obtain the sample and gather sensitive data. Maintaining a culture of trust was crucial in recovering from damaging environmental events that threatened data collection.
TL;DR: It is concluded that high psychiatric comorbidity in spasmodic torticollis is unlikely to be a mere consequence of chronic disease and disfigurement.
Abstract: Disturbed body image and negative self-referent cognitions caused by the postural disfigurement of the head are regarded as the main reason for elevated depression scores in spasmodic torticollis (ST), but this factor was never controlled for. We therefore compared 48 patients with ST and 48 patients with alopecia areata (AA) who were matched for age, sex, and body image dissatisfaction. Psychiatric diagnoses were based on a structured psychiatric interview (SCID-I). Results of patients with ST and AA were compared with a matched sample of the representative German population. Odds ratios to develop psychiatric comorbidity for patients with ST compared with patients with AA were significantly increased throughout nearly all assessed DSM-IV categories. Logistic regression analysis showed that (1) depressive coping and (2) belonging to the group of patients with ST correlated with a significantly higher rate of current psychiatric diagnosis. We conclude that high psychiatric comorbidity in ST is unlikely to be a mere consequence of chronic disease and disfigurement.
TL;DR: The findings suggest that PTSD does not appear to alter the central features of BPD, and both groups of women with PTSD reported significantly more types of childhood traumas relative to borderline women without PTSD.
Abstract: The aims of this study were to examine differences in clinical features, impairment, and types of childhood traumas among women with borderline personality disorder (BPD), women with BPD and posttraumatic stress disorder (PTSD), and those with other personality disorders and PTSD. Using baseline data from the Collaborative Longitudinal Study of Personality Disorders, 186 women were divided into 3 groups (BPD+PTSD, BPD, PTSD), based on structured diagnostic interviews for Axis I and Axis II disorders and compared on selected clinical variables. The additional diagnosis of PTSD in borderline women did not significantly increase the degree of borderline pathology and psychiatric morbidity but did significantly increase general dysfunction and the occurrence of hospitalization. The additional diagnosis of BPD in women with PTSD significantly increased the features of suicide proneness and impulsiveness. Both groups of women with PTSD reported significantly more types of childhood traumas relative to borderline women without PTSD. Consistent with other research, the findings suggest that PTSD does not appear to alter the central features of BPD. The clinical implications of our findings are considered.
TL;DR: Supporting employment programs appear to work by helping clients compensate for problematic symptoms and cognitive impairment and, to a lesser extent, by finding or developing environmental niches in which these impairments do not impede their ability to perform the necessary job tasks.
Abstract: This study compared cognitive functioning and symptomatology of unemployed, supported employed, and independently employed clients with severe mental illness. Unemployed clients who wanted to work (N = 21) were compared with clients working in supported employment programs (N = 17) and clients who had been working independently for at least 1 year (N = 23) on a neuropsychological battery and the Positive and Negative Syndrome Scale. Clients who were unemployed had more severe symptoms and worse cognitive functioning on both positive and negative symptoms, and almost all domains of cognitive functioning. Supported employed clients had more severe psychotic symptoms and worse working memory than independently employed clients, but did not differ in negative symptoms or the other domains of cognitive functioning, including attention/concentration, psychomotor speed, verbal learning and memory, or executive functions. Finally, job complexity was correlated with impaired executive functions among clients working independently, but not in supported employment. Severe symptoms and cognitive impairment may interfere with the ability of some clients with severe mental illness to obtain competitive work. Supported employment programs appear to work by helping clients compensate for problematic symptoms and cognitive impairment and, to a lesser extent, by finding or developing environmental niches in which these impairments do not impede their ability to perform the necessary job tasks.
TL;DR: Predictions and correlational analyses supported predictions and suggest that Eysenckian domains of personality may promote or hinder a person’s progression along the continuum of behaviors associated with celebrity worship.
Abstract: The phenomenon of celebrity worship is currently conceptualized as an abnormal type of parasocial relationship, driven by absorption and addictive elements and which potentially has significant clinical sequelae. The authors hypothesize that the three increasingly extreme sets of attitudes and behaviors associated with celebrity worship also partly reflect the three domains of personality discussed in Eysenckian theory. Specifically, celebrity worship for entertainment-social reasons may reflect extraversion personality traits; intense-personal attitudes and behaviors toward celebrities may reflect neuroticism traits; and celebrity worship of a borderline-pathological nature may reflect psychoticism traits. To test this idea, the authors administered the Celebrity Attitude Scale and the Abbreviated Form of the Revised Eysenck Personality Questionnaire to large convenience samples of students (N = 317) and community (N = 290) respondents. Results indicate that celebrity worship is not an uncommon phenomenon. Further, correlational analyses supported predictions and suggest that Eysenckian domains of personality may promote or hinder a person's progression along the continuum of behaviors associated with celebrity worship.
TL;DR: A multifunctional narrative approach to insight into mental disorder is developed, and implications of this approach for psychiatric rehabilitation research and for Psychiatric rehabilitation intervention are explored.
Abstract: Many people with a psychiatric disability appear to exhibit varying degrees of lack of awareness of the mental disorder that is implied by their diagnosis. Furthermore, there is considerable controversy regarding the significance of being aware of and acknowledging a psychiatric disorder. Different responses to the issues underlying this controversy can be found in the professional and research literature. This article describes and compares some of these responses. On the basis of this description and comparison, a multifunctional narrative approach to insight into mental disorder is developed, and implications of this approach for psychiatric rehabilitation research and for psychiatric rehabilitation intervention are explored.
TL;DR: Levels of three personality dimensions—neuroticism, extraversion, and agreeableness—are associated with symptomatology and coping in persons with schizophrenia are examined to find links between extraversion and outcome measures.
Abstract: While individual differences in personality exist among persons with schizophrenia and predate the onset of illness, less is known about their relationship to outcome. This study examined whether levels of three personality dimensions-neuroticism, extraversion, and agreeableness-are associated with symptomatology and coping in persons with schizophrenia. Symptom, personality, and coping measures were obtained for 59 participants with schizophrenia. Personality and coping measures were obtained for 17 persons in a community comparison group. Relative to the community comparison groups, participants with schizophrenia had higher levels of neuroticism, lower levels of extraversion and agreeableness, and tended to employ more avoidant styles of coping. Participants with schizophrenia who had higher levels of neuroticism had greater positive and emotional discomfort symptoms and greater preferences for avoidant coping strategies. Participants with schizophrenia who had higher levels of agreeableness had lower levels of positive and excitement symptoms. No links were found between extraversion and outcome measures. Implications for understanding how personality may affect outcome are discussed.
TL;DR: It is concluded that homeless people with mental illness are at particularly high risk for suicidal behavior, however, only in part because of the high prevalence of traditional risk factors.
Abstract: This study utilized data from the national ACCESS program (N = 7224) to investigate the prevalence of suicidal ideation and suicide attempts in a sample of homeless people with mental illness. The prevalence of suicidal ideation in this sample was high (66.2% lifetime prevalence). In addition, 51.3% of the sample reported that they had ever attempted suicide, 26.9% reported an attempt that resulted in a nonpsychiatric hospitalization, and 8% reported an attempt in the previous 30 days. Youth, substance abuse, and psychiatric symptoms were all significantly associated with suicide attempts. Those who reported a recent attempt also reported higher rates of mental health care utilization, particularly inpatient care. The authors conclude that homeless people with mental illness are at particularly high risk for suicidal behavior, however, only in part because of the high prevalence of traditional risk factors.
TL;DR: It is found that deficit schizophrenia subjects, but not nondeficit subjects, had an increased density of microtubule-associated protein 2-immunoreactive ICWMs, and group differences provide further evidence that deficit and nondefield schizophrenia differ in their pathophysiology.
Abstract: An increased density of neurons in the white matter of the neocortex has been found in schizophrenia, and the original reports suggested this abnormality was restricted to a subgroup of patients. In a study of the inferior parietal cortex, we found that deficit schizophrenia subjects, but not nondeficit subjects, had an increased density of ICWMs. We extended that finding by comparing the density of microtubule-associated protein 2-immunoreactive ICWMs in deficit schizophrenia (N = 3), nondeficit schizophrenia (N = 4), and control (N = 5) subjects, using postmortem tissue from the dorsolateral prefrontal cortex (Brodmann area 46). The deficit group differed significantly from the other two groups; the respective mean (SD) density values for the deficit, nondeficit, and control groups were 1.27 (.10), .53 (.39), and .76 (.20) cells per 10−6 cubic microns. These group differences provide further evidence that deficit and nondeficit schizophrenia differ in their pathophysiology.
TL;DR: Results failed to support a link between parental control and the development of an eating disorder, and implications from a cross-cultural perspective are addressed.
Abstract: This study is an examination of the influence of sociocultural and developmental factors on body dissatisfaction and disordered eating attitudes and behaviors in two Asian populations: 298 Taiwanese-American (TA) women undergoing acculturating changes and 347 Taiwanese (T) women undergoing modernizi