Search

Background: A structure of everyday life creates routines and a sense of familiarity, which provides a recognizable basis for being and acting in the world. A structure of everyday life reduces stress, and daily stress has consistently been associated with higher levels of psychiatric symptoms. Little is known about how patients with schizophrenia and severe social impairment structure their lives. Thus, we aimed to explore the everyday lives of this group of patients, looking for structuring elements. Methods: In this qualitative study, we included patients diagnosed with schizophrenia who were either homeless or had difficulties reporting for treatment and, thus, needed treatment from an outreach team. Results: 17 participants were included in the study. We found only few structuring elements across all participants in the qualitative analyses. We identified five themes in our sample that serve as structuring elements in the everyday life: social interactions, volunteering to assist with basic tasks, self-initiated routines such as going for a walk daily, exoskeleton (structure provided by others), and having pets. None of the participants reported much activity during the day, and for most of them, social interactions were minimal. Discussion: All the participants had very little structure and routines in their everyday life. The shelters provided the homeless participants with some structuring elements, whereas the domiciled participants had no external structuring elements. The findings have important implications for psychosocial treatment of severe social impairment in schizophrenia. The lack of structure in these patients' everyday lives highlights the need for targeted interventions that could facilitate such structures and guide social involvement and personal recovery. [ABSTRACT FROM AUTHOR]

Background and Hypothesis The idea that a disorder of the basic self is a central feature in schizophrenia has recently been corroborated in a meta-analysis and a systematic review. Manifestations of the self-disorder can be systematically explored with the Examination of Anomalous Self-Experience (EASE). In this study, we examined the factorial structure of EASE, and diagnostic efficacy of EASE. We hypothesized that EASE will have a monofactorial structure as an instability of the basic self will result in multiple deformations of self-experience which would be meaningfully interrelated as aspects of a unifying Gestalt. Design EASE data for 226 patients suffering from various mental disorders were analyzed under a confirmatory factor analysis framework (CFA). Area under the receiver operating characteristic curve (AUC) was calculated for the total EASE sums, and sensitivity and specificity values for prediction of schizophrenia spectrum disorders based on different cut-offs were obtained. Results Fit indices for the CFA model: RMSEA = 0.036, SRMR = 0.100, CFI = 0.983, TLI = 0.981. The AUC value was 0.946 (95% confidence interval: 0.919–0.974). Sensitivity as well as specificity for schizophrenia spectrum disorders were high. Conclusion Our results lend support for EASE exhibiting a monofactorial structure and the notion of self-disorders as a central phenotypic feature of schizophrenia spectrum disorders. [ABSTRACT FROM AUTHOR]

Schizophrenia (SCZ) can be characterized as a basic self-disorder that is featured by abnormal temporal integration on phenomenological (experience) and psychological (information processing) levels. Temporal integration on the neuronal level can be measured by the brain's intrinsic neural timescale using the autocorrelation window (ACW) and power-law exponent (PLE). Our goal was to relate intrinsic neural timescales (ACW, PLE), as a proxy of temporal integration on the neuronal level, to temporal integration related to self-disorder on psychological (Enfacement illusion task in electroencephalography) and phenomenological (Examination of Anomalous Self-Experience [EASE]) levels. SCZ participants exhibited prolonged ACW and higher PLE during the self-referential task (Enfacement illusion), but not during the non-self-referential task (auditory oddball). The degree of ACW/PLE change during task relative to rest was significantly reduced in self-referential task in SCZ. A moderation model showed that low and high ACW/PLE exerted differential impact on the relationship of self-disorder (EASE) and negative symptoms (PANSS). In sum, we demonstrate abnormal prolongation in intrinsic neural timescale during self-reference in SCZ including its relation to basic self-disorder and negative symptoms. Our results point to abnormal relation of self and temporal integration at the core of SCZ constituting a "common currency" of neuronal, psychological, and phenomenological levels. [ABSTRACT FROM AUTHOR]

Background: Psychosis and signs of severe mental disorders such as schizophrenia often emerge in adolescence. Much attention has been devoted to identifying the individuals experiencing psychosis at an early stage. Implementation of early detection services is widely acknowledged as effective in reducing treatment delays. However, little is known about the diagnostic patterns of individuals entering an early detection service regardless of the initial psychopathological evaluation. The aim of the study is to investigate the diagnostic trajectories of individuals evaluated by an early detection of psychosis unit. Methods: A real-life cross-sectional study coupling register data with information of diagnoses allocated by clinical evaluation in an early detection unit. All individuals clinically evaluated in the early detection unit from 2012 to 2015 were included. A Central Psychiatric Research Register was searched for lifetime allocated diagnoses. Register search allowed a minimum of one-year follow-up after evaluation. To determine the predictive ability of the early detection unit, diagnoses allocated by the initial clinical evaluation were compared to later diagnoses in psychiatric services. Results: In total 450 individuals were clinically evaluated in the early detection unit during a period of 3 years. Previously 174 (39 %) patients had been in contact with mental healthcare services, and 28 (6.2%) had previously been diagnosed with psychosis. During follow-up, a diagnosis of psychosis was allocated in 146 (32.4%) of all evaluated individuals. In the clinical assessment by the early detection unit 107 (73.3 %) were diagnosed with psychosis. In total 39 (14.7%) were assessed false negative for psychosis by the early detection unit, they were later diagnosed with psychosis in mental healthcare services. The majority of psychosis diagnoses was allocated within one year after assessment in the early detection unit and half of individuals who were diagnosed with psychosis was re-diagnosed with schizophrenia (n=73). The hazard ratio of receiving a diagnosis of psychosis subsequently in mental healthcare services in individuals diagnosed with psychosis by the early detection unit was 4.73 (95 % CI: 3.01 – 7.44, p < 0.0001) compared to individuals not found psychotic by the early detection unit. Discussion: That more than a third of the clinical evaluated has previously been help-seeking in mental healthcare system demonstrates a source of delay in treatment, suggesting that contact to other parts of mental healthcare services can delay detection of psychosis. Of the individuals not evaluated cases of psychosis 15 % later received a diagnose of psychosis. This suggests that an important subgroup of the help-seeking individuals undergoes transition to psychosis after contact or that detection of psychosis has not been possible by evaluation in the early detection unit. In conclusion, attention should be made to all individuals self-referred to an early detection unit, as diagnoses of psychosis is seen in the majority within the first year after contact. Also in individuals not initially suspected of psychosis. [ABSTRACT FROM AUTHOR]