Showing papers in "Psychosis in 2011"
TL;DR: An open dialogue need-adapted approach was applied in Finnish Western Lapland by organizing three-year family therapy training for the entire staff, and by following the outcomes, which suggested that the new practice can be related to profound changes in the incidence of severe mental health problems.
Abstract: An open dialogue need-adapted approach was applied in Finnish Western Lapland by organizing three-year family therapy training for the entire staff, and by following the outcomes. Three inclusion periods of first-episode psychotic patients were compared. In a two-year follow-up of two consecutive periods during the 1990s (1992–3 and 1994–7) it was found that 81% of patients did not have any residual psychotic symptoms, and that 84% had returned to full-time employment or studies. Only 33% had used neuroleptic medication. A third inclusion period, covering 2003–2005, was organized to determine whether the outcomes were consistent 10 years after the preliminary period. Fewer schizophrenia psychotic patients emerged, and their mean age was significantly lower. Duration of untreated psychosis had shortened to three weeks and the outcomes remained as good as for the first two periods. It is therefore suggested that the new practice can be related to profound changes in the incidence of severe mental health pro...
214 citations
TL;DR: It can be argued that the ODA has been helpful, at least in moving the commencement of treatment in a less chronic direction, and may have even increased social capital in the entire psychiatric catchment area, and promote mutual trust between the general population and the psychiatric services.
Abstract: Mental health services in a health district in Finland with a population of 72,000 were developed into a comprehensive family- and network-centered entity by giving all the psychiatric personnel training in family therapy or psychodynamic individual therapy, and by arranging a system in which all psychiatric crises were treated in a family- and network-centered manner by multidisciplinary crisis teams, mostly in the patient’s home. The system is a modification of the Need-Adapted Approach called the Open-Dialogue Approach (ODA). The changes in the incidence of first-contact non-affective psychoses and prodromal states were studied in two cities of the District, considering the five-year periods before and after the system was fully established. The mean annual incidence of schizophrenia decreased, brief psychotic reactions increased, and the incidence of schizophreniform psychoses and prodromal states did not change. The number of new long-stay schizophrenic hospital patients fell to zero. It can be argue...
130 citations
TL;DR: The authors used a qualitative approach to develop a definition of hearing voices based on the essential characteristics of the experience, which revealed that the content of the voices is personally meaningful, the voices have a characterised identity, the person has a relationship with their voices, and the experience has a significant impact on the voice-hearer's life.
Abstract: Despite an increasingly comprehensive research literature on hearing voices, few attempts have been made to define the phenomenon and fewer still have sought to do so based on voice‐hearers' subjective accounts. This paper uses a qualitative approach to develop a definition of hearing voices based on the essential characteristics of the experience. Fifty voice‐hearers from the general population participated in semi‐structured interviews exploring their voice experiences. Thematic analysis revealed five essential characteristics: the content of the voices is personally meaningful, the voices have a characterised identity, the person has a relationship with their voices, the experience has a significant impact on the voice‐hearer's life, and the experience has a compelling sense of reality. Implications for treatment interventions include the importance of acknowledging that voices are real, supporting the person to make meaning of who the voices are and what the voices say, and making connections between ...
95 citations
TL;DR: In this paper, the authors examined the relationship between reports of auditory hallucinations and dissociative experiences in the daily lives of patients with psychosis and found that patients who hallucinated during the assessment period (n = 21) reported elevated levels of dissociation compared to non-hallucinating patients and health care workers.
Abstract: Primary objectives: It has been proposed that dissociation plays a role in the aetiology of hallucinatory experiences. The present study examined the relationship between reports of auditory hallucinations and dissociative experiences in the daily lives of patients with psychosis. The influence of everyday stressors on dissociation and on the hypothesised relationship between dissociation and hallucinatory experiences was also investigated. Finally, this study examined the association between hallucinations and other non‐dissociative dysfunctional strategies used to suppress unpleasant mental events (i.e. experiential avoidance). Method: Forty‐two patients with a diagnosis of schizophrenia spectrum disorder and 23 healthy controls were studied for six days using the Experience Sampling Method (ESM), a structured self‐assessment diary technique. Results: Patients who hallucinated during the assessment period (n = 21) reported elevated levels of dissociation compared to non‐hallucinating patients and health...
58 citations
TL;DR: In this article, the Internal, Personal and Situational Attributions Questionnaire (IPSAQ) was administered to 29 schizophrenia patients (10 with current paranoia), 26 psychiatric patients (OCD) and 33 healthy controls.
Abstract: Attributional biases are assumed to be part of the pathogenesis of persecutory delusions. The aim of the present study was to explore whether such biases are confined to current paranoid delusions or related to other positive symptoms as well. Another goal was to investigate whether current paranoid schizophrenia patients only show an exaggerated personalizing bias for negative events (i.e. personalizing blame) or also tend to externalize responsibility for positive events (i.e. decreased sense of self‐causation). The Internal, Personal and Situational Attributions Questionnaire (IPSAQ) was administered to 29 schizophrenia patients (10 with current paranoia), 26 psychiatric patients (OCD) and 33 healthy controls. Acutely paranoid patients made fewer internal attributions for positive and negative events, thus replicating a previously reported decreased sense of self‐causation. This kind of attributional style was related to acute positive symptomatology, but not to persecutory beliefs in particular. No ev...
52 citations
TL;DR: In this article, the authors focus on the dimension of care being "person-centered" in order to explore in some depth its implications for transforming psychiatric practice and argue that several different forms of love are required by the nature of the threat to the person's sense of self posed by psychosis.
Abstract: Of the various ways in which recovery‐oriented practice has been characterized in contrast to traditional care, this paper focuses on the dimension of care being “person‐centered” in order to explore in some depth its implications for transforming psychiatric practice. In order to be considered “person‐centered”, care must attend primarily to the person rather than to symptoms or to diagnosis. In addition to respecting the person’s autonomy, we suggest that “person‐centered” care also requires a re‐thinking of the traditional therapeutic stance of neutrality in favor of a more engaged, compassionate stance which falls under the broad rubric of “love”. We argue that several different forms of love are required by the nature of the threat to the person’s sense of self posed by psychosis. In agreement with both Western and Eastern philosophical and spiritual traditions, we suggest that recognizing and restoring a person’s “personhood” is fundamentally a loving act. We then distinguish four different forms of...
30 citations
TL;DR: In this paper, an integrated model is presented in which psychodynamic psychotherapy and cognitive behavioral therapy of psychosis fit together, with each modality playing an essential role in different ways at different points over the course of treatment.
Abstract: Some clinicians regard psychodynamic psychotherapy (PP) and cognitive behavioral therapy of psychosis (CBTp) as treatments with little in common. An integrated model is presented in which PP and CBTp fit together, with each modality playing an essential role in different ways at different points over the course of treatment. This model is developed by examining a core symptom in psychosis. Psychotic individuals seemingly perceive events in the outside world which are actually reflections of internal mental processes. Instead of experiencing thoughts or feelings, a person “sees” or “hears” things which appear to be occurring outside the self, a “thing presentation” of mental life. Before the unconscious meaning of psychotic symptoms can be psychodynamically interpreted to a person, “thing presentations” of mental life must first be returned within the boundary of the self. CBTp provides the technical means to do this. Once CBTp has helped re‐establish connections between psychotic experience and internal e...
26 citations
TL;DR: In this article, firstperson accounts and detailed phenomenological descriptions are used to improve our understanding of auditory verbal hallucinations (AVHs) and to increase the communication and shareability of such experiences.
Abstract: First‐person accounts and detailed phenomenological descriptions are decisive to improve our understanding of auditory verbal hallucinations (AVHs). This is crucial in order to adequately appreciate the biographical–existential complexity of the “voices” and to increase the communication and share‐ability of such experiences. Besides the clear normalizing/de‐stigmatizing value, such an approach has an eminent therapeutic value since it offers a non‐reifying way to approach the broad, gestaltic metamorphosis of consciousness which precedes fully formed, florid AVHs. However, an important feature – namely, the very experiential genesis of the voices before their manifestation as full‐blown AVHs – has up to now not received sufficient attention. “Voices” indeed are often anticipated by subtle pre‐psychotic distortions of the stream of consciousness – such as abnormal sonorization of the inner dialogue and/or perceptualization of thought – which could emerge at the beginning of the prodromal phase. We suggest...
23 citations
TL;DR: An intervention program can be useful in increasing attention to service user involvement in inpatient mental health services, and was not associated with inpatients reporting more satisfaction with care.
Abstract: Background: Modern mental health strategies emphasize the necessity of user participation, but only a few studies examine how user involvement can be promoted effectively. Aim: To study the possible effect of an intervention program designed to (1) increase attention to user involvement and (2) increase user involvement at the inpatient departmental level. Methods: The study has a quasi‐experimental design, involving inpatient departments in five Norwegian Community Mental Health Centers (CMHCs). Two CMHCs received the intervention, and were compared with three CMHCs that did not. The impact of the intervention was assessed with the Service User Involvement in Mental Health Scale (SUIM), a selection of items from the Consumer Participation Questionnaire (CPQ) and the Psychiatric Inpatient Experience Questionnaire (PIPEQ). One hundred and twenty‐three service providers, 51 in the intervention group and 72 in the comparison group, and 47 inpatients took part in the study. Results: Providers in the intervent...
22 citations
TL;DR: A short psychosocial intervention involving a testimonial from an ex‐service user can lead to small but significant reductions in teenagers' discrimination about psychosis immediately after the intervention.
Abstract: Aim: To examine the effectiveness of a psychosocial mental health promotion workshop, involving an ex‐service‐user researcher, in reducing discrimination about psychosis in teenagers. Hypothesis: Pupils in the intervention condition will express less discrimination about a man characterised as having experienced psychosis immediately after the workshop and at follow‐up, compared with pupils in the control condition. Method: A cluster randomised trial was carried out in order to take into account the effect of class group. Ninety‐two pupils participated at baseline; 43 pupils were exposed to the intervention and 49 pupils formed the control group. Pupils completed demographic information, questions about their familiarity with people with mental health problems and a questionnaire examining discrimination about psychosis. Results: Multi‐level modelling was used to analyse the results. Discrimination scores in the intervention group reduced significantly more than the control group immediately after the int...
22 citations
TL;DR: This story is a live testimony confirming what many people want to deny: it confirms that a human being suffering from schizophrenia has the same needs as all of us who consider ourselves as normal.
Abstract: edited by Jonathan Radcliffe, Katja Hajek, Jerome Carson & Oded Manor, London, Whiting & Birch Ltd, 2010, 362 pp., £35.95 (paperback), ISBN 9781861771186. It may seem to many that the title of this...
TL;DR: In this article, the authors report the findings of a narrative analysis of the accounts of four siblings, two male and two female, aged between 17 and 24 years, of young people with a first episode of psychosis.
Abstract: Research investigating the impact and experience of first episode psychosis amongst siblings is limited. This study reports the findings of a narrative analysis of the accounts of four siblings, two male and two female, aged between 17 and 24 years, of young people with a first episode of psychosis. The aim of the analysis was to explore the impact of this experience on siblings’ sense of self and their identity development and the roles they adopt within their families. The analysis focused on the core narrative, tone and genre of each account as well as providing a cross-case analysis. This cross-case analysis indicated an overarching genre of “rite of passage” within which a gender difference was interpreted. The emphasis in the accounts of the two young women was on finding personal meaning whereas, for the two young men, the emphasis was on taking up responsibilities. As found in other studies of serious mental health problems, siblings provide much direct and indirect care for their families. The implications for services providing support to siblings and families in early intervention services are discussed.
TL;DR: A pilot study investigating whether online normalising information in the form of an audio podcast could challenge negative appraisals of psychotic experiences in the general population found a significant reduction in participants' scores, and a significant increase in their scores on a measure of normalising beliefs about paranoia.
Abstract: Cognitive models of psychosis suggest that challenging negative appraisals of psychotic experiences could directly reduce associated distress and stigma. A pilot study investigating whether online normalising information in the form of an audio podcast could challenge negative appraisals of psychotic experiences in the general population was conducted. Within‐subject change in negative appraisals of psychotic experiences and knowledge of prevalence of psychotic experiences were evaluated using pre‐ and post‐podcast self‐report questionnaires. One hundred and forty‐six people provided partial or full responses to a pre‐podcast assessment, and 49% returned to complete follow‐up measures. There was a significant reduction in participants' scores on measures of negative appraisals of auditory hallucinations and paranoia, a significant increase in their scores on a measure of normalising beliefs about paranoia and a significant increase in their estimates of the prevalence of psychotic experiences. The results...
TL;DR: In this paper, seven friends were interviewed about their experience of being friends with a young person with psychosis and the central category that emerged was "persisting with the friendship", a chronological process that unfolded over time, from the point at which friends began to notice initial psychotic symptoms, through to thinking about what the future might hold.
Abstract: Psychosis has a concerning social impact and can lead to significant reductions in social networks early in its course. There are serious developmental and illness-related implications of reduced social networks which make it important to understand why this occurs. This study aimed to explore the often neglected perspective of friends in order to advance our understanding of the reasons for breakdowns in relationships following the onset of psychosis. Seven friends were interviewed about their experience of being friends with a young person with psychosis. Constructivist Grounded Theory was used to analyse the transcripts and develop a theoretical model. The central category that emerged was “persisting with the friendship”, a chronological process that unfolded over time, from the point at which friends began to notice initial psychotic symptoms, through to thinking about what the future might hold for the young person with psychosis. A number of factors impacted on friends’ ability to persist with the ...
TL;DR: If persons with a diagnosis of schizophrenia lack insight into their illness because cognitive deficits prevent them from applying an internal schema of mental illness to themselves, then the ability of subjects to “insightfully” classify a series of short, fictional vignettes from a third‐person perspective is examined.
Abstract: Objective: The purpose of this study was to determine if persons with a diagnosis of schizophrenia lack insight into their illness because cognitive deficits prevent them from applying an internal schema of mental illness to themselves. The study examines the ability of subjects to “insightfully” classify a series of short, fictional vignettes from a third‐person perspective. Method: Investigators wrote 20 one‐ to three‐sentence stories, 11 illustrating subtypes of psychotic symptoms, 3 illustrating non‐psychotic psychiatric diagnoses, 3 indicating medical problems, and 3 no illness. The investigators read these stories to a sample of inpatients with a diagnosis of schizophrenia and a random community sample control group, and asked if subjects considered the person in each story to be mentally ill. Results: Subjects and controls were able to make accurate, fine distinctions among medical illness, no illness, and psychiatric illness categories. Conclusions: Patients did not demonstrate a deficit in the co...
TL;DR: The recent UK clinical guidelines for psychosis require an integration of biomedical and psychological treatment approaches that may present challenges to the structure and delivery of services as discussed by the authors, and an open, critical examination of existing professional models and practices is required to ensure that optimal service provision.
Abstract: The recent UK clinical guidelines for psychosis require an integration of biomedical and psychological treatment approaches that may present challenges to the structure and delivery of services. This review briefly outlines these two approaches before presenting arguments both for and against their compatibility. Although this discussion recognises attempts at integrating the approaches in modern mainstream services, it argues that their fundamental theoretical differences entail very different treatment methods, and often require conflicting demands of clients. Not only is this potentially confusing and unhelpful to the clients, but it also interferes with the goals and processes of each approach. Some of the main challenges to integration are discussed, and suggestions are made regarding the future direction of multidisciplinary treatments for psychosis. This review argues that an open, critical examination of existing professional models and practices is required to ensure that optimal service provision.
TL;DR: The authors describe the characteristics and the preliminary findings of the Early Care Team for At‐Risk of Psychosis Patients (EAPPP), within the public Primary Health Care System of Barcelona, Spain.
Abstract: The authors describe the characteristics and the preliminary findings of the Early Care Team for At‐Risk of Psychosis Patients (EAPPP), within the public Primary Health Care System of Barcelona, Spain. The community‐focused work and the psychological and inter‐paradigmatic framework are highlighted as core components of the EAPPP unit in the field of Early Care of Psychosis. Some initial findings in relation to three groups of patients are presented.
TL;DR: In this paper, the authors describe the importance of understanding my human experience thus far and how past events and experiences have shaped me into the person I am today, and the possibilities of recovery are endless.
Abstract: I now come from the very firm belief that people can and do recover, that people are not defined by illness or diagnosis. I also believe that we need to look at people as a whole. Two years ago, however, I was firmly convinced that I was defined by my illness and limited by my diagnosis. I was told I could not live the life that I wanted and that I would need medication forever. I was never told I could recover. My journey was not an easy one and there were many occasions when I wanted to give up. Throughout my journey I discovered the importance of understanding my human experience thus far and how past events and experiences have shaped me into the person I am today. The story of recovery is still not a common enough story, but the possibilities of recovery are endless! Recovery is much more than becoming stable; it’s about bettering who you are and finding meaning. Recovery was made possible for me by people having hope that I could find myself again; people seeing past the so-called illness and seeing...
TL;DR: It is urged that all means, including the media, be used to raise public awareness about the need to end the sexual abuse of children, particularly within the family.
Abstract: Public education campaigns are needed to proclaim the right of children to be safe in their own homes and to encourage both abusers and victims to seek help. Broad‐based discussion of this problem,...
TL;DR: This paper is in response to a previous Opinion Piece – “Psychosis, dissociation or delirium? Observations on the importance of differential diagnosis”.
Abstract: This paper is in response to a previous Opinion Piece – “Psychosis, dissociation or delirium? Observations on the importance of differential diagnosis”.
TL;DR: Sometimes a psychosis, a dissociative pseudo‐psychosis or a delirium – especially when overlapping – are not diagnosed as aetiologically separate entities in clinical situations.
Abstract: Sometimes a psychosis, a dissociative pseudo‐psychosis or a delirium – especially when overlapping – are not diagnosed as aetiologically separate entities in clinical situations. All may be named “psychosis” or even schizophrenia. Such a practice may give serious consequences for the treatment. The observations in this paper will hopefully act as an invitation for other colleagues’ commentaries.
TL;DR: The main results of outcome research on psychosocial treatment in group format with people diagnosed with schizophrenia are summarized and critically discussed with respect to methodological shortcomings.
Abstract: Psychosocial treatment in group format with people diagnosed with schizophrenia has been applied for decades. Meta-analyses and reviews support the clinical impression that psychosocial treatment in group format is effective. The most investigated forms of group treatment are social skills groups, psycho-educational groups with patients and families, and cognitive-behavioural therapy. Psychodynamic approaches and traditional verbal therapies in group settings are frequently applied but have not been sufficiently investigated to date. In this article, the main results of outcome research on psychosocial treatment in group format with people diagnosed with schizophrenia are summarized and critically discussed with respect to methodological shortcomings. The need for more research on psychodynamic approaches and group processes is also emphasized.
TL;DR: Clinical interviews suggest that the type of interview has importance for the facial affectivity in patients diagnosed with schizophrenia during mutual gaze.
Abstract: Background: Some patients diagnosed with schizophrenia display reduced amounts of negative facial affectivity during mutual gaze in everyday conversations with non‐professionals. Aims: The aim was to confirm this finding in clinical interviews. Method: Thirty‐two video‐recorded clinical interviews were conducted with eight patients diagnosed with schizophrenia. Selected sequences were coded for gaze behaviour and facial affective behaviour. Results: During mutual gaze, the patients showed as much negative facial affectivity as expected by chance. Previous findings were not confirmed. Conclusions: Findings suggests that the type of interview has importance for the facial affectivity in patients diagnosed with schizophrenia during mutual gaze.
TL;DR: The authors investigated whether a person's belief in a just world (BJW) or knowing someone treated for a mental health problem was related to their attitudes towards those with a diagnosis of mental illness or to their beliefs about the causes of mental health problems.
Abstract: This study investigated whether a person’s belief in a just world (BJW) or knowing someone treated for a mental health problem was related to their attitudes towards those with a diagnosis of mental illness or to their beliefs about the causes of mental health problems. One hundred and seventy three participants completed a questionnaire measuring BJW, attitudes towards, and causal beliefs about, mental health problems. No relationship was found between BJW and attitudes, nor between psychosocial causal beliefs and attitudes. However, bio-genetic causal beliefs were associated with attitudes. Those who knew someone who had received treatment for a mental health problem had lower bio-genetic belief scores than those who did not. However, there were no differences between the two groups in BJW, attitudes or psychosocial beliefs.
TL;DR: In this paper, the authors encourage people to listen to the stories of the people they work with, as they walk alongside them through some of the extremes of their life experiences, and to not lose sight of the storyteller or the sense they are making of their experiences.
Abstract: Our stories help us to make sense of the world we are living in and sometimes those stories make no sense at all to those outside of our experiences. I am here to encourage you to listen to the stories of the people you work with, as you walk alongside them through some of the extremes of their life experiences. There will be people who challenge you, who stretch you to the absolute limits of your psyche, to North, South, East and West of your emotional and spiritual capacity of your own being in the world. But stay alert and stay alive to their stories, as they are often desperate metaphors of unspeakable experiences. These stories need to be heard. Do not lose sight of the storyteller or of the sense they are making of their experiences. I urge you to listen to them. Because these are often disenfranchised voices, the unheard stories of the dispossessed.
TL;DR: Romme and Escher as discussed by the authors, 2011, 232 pp, £55.00/US$90.00 (hardback), ISBN 978-0-415-67331-0; £20.99/$33.95 (paperback)
Abstract: edited by Marius Romme and Sandra Escher, London, Routledge, 2011, 232 pp, £55.00/US$90.00 (hardback), ISBN 978-0-415-67331-0; £20.99/$33.95 (paperback), ISBN 978-0-415-67330-3 This is a landmark b...
TL;DR: In this article, the authors present the case of a 21-year old woman who developed a delusional system of beliefs within the context of her religious and cultural experiences as well as substance use, which ultimately led to her decision to swallow the key to a door while undergoing clinical investigations in hospital.
Abstract: We present the case of a 21‐year old woman who developed a delusional system of beliefs within the context of her religious and cultural experiences as well as substance use. This ultimately led her to carry out bizarre behaviors which culminated in her decision to swallow the key to a door while undergoing clinical investigations in hospital. The act of, and motivation for, swallowing the key as well as the patient’s other unusual behaviors and beliefs are explored. We demonstrate how seemingly inexplicable psychotic behaviors can be better understood through a consideration of pertinent sociocultural issues. Clinical interventions and the patient’s response to treatment are also described.
TL;DR: It is suggested that some youth may have the ability to self‐identify mental disturbances at very early ages, and further research is needed to explore developing screening and assessment tools facilitating the systematic inclusion of child self‐report information in clinical interviews.
Abstract: Purpose: To report on young people's accounts of retrospective subjective knowledge of early distress. Method: Semi‐structured interviews were conducted with 49 youth, 22 female and 27 male, aged 16–26 living with mental health problems in Canada, USA, and Australia. Results: Some youth self‐reported being “aware” of mental problems as early as 4 and 5 years of age; however, as a group, youth were not officially diagnosed until between 11 and 24 years of age. Overall, the average youth‐identified duration of untreated mental disorder (YIDUMD) was 4.73 years, with 5 youth being diagnosed and treated at less than one year from self‐identified onset. Conclusion: The complexities of childhood make the accuracy of diagnosing mental disorders at early ages difficult. This research suggests that some youth may have the ability to self‐identify mental disturbances at very early ages. Therefore, further research is needed to explore developing screening and assessment tools facilitating the systematic inclusion of...
TL;DR: In this paper, the authors examined the relationship between use of cannabis and psychotic experiences in undergraduate students and found that current cannabis use and frequency of use were associated with elevated levels of psychotic experiences.
Abstract: Cannabis use may be related to psychotic experiences in the general population. However, few studies have examined this relationship in undergraduate students despite high levels of cannabis use in this population. A sample of 334 undergraduate students (mean age = 22.2 years; 85.2% female, 14.8% male) from Britain, Ireland, Canada, USA, Australia and New Zealand took part in the study. Participants completed an author‐constructed questionnaire measuring cannabis use, and questions on psychosis from the Diagnostic Interview Schedule (DIS‐P) as adapted for self‐report format. No significant difference was found between those who had used cannabis at some point in their lives and those who had not. However, current cannabis use and frequency of use were associated with elevated levels of psychotic experiences. Level of consumption was also related to such experiences, but there was no effect of age of first use.