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Cette note de recherche se situe à la confluence de deux types d'écrits en santé mentale. D'un côté, un nombre croissant de recherches questionnent la frontière entre la psychopathologie et [...]

Background: The study investigated the meaning of recovery to eight people with chronic schizophrenia. Method: A qualitative methodology was used based on a 3-hour focus group. The material was transcribed and analysed into 18 subcategories and 4 categories; namely recovery as a multi-dimensional construct, the relationship of medication to recovery, a sense of hopelessness and helplessness about recovery, factors that promoted recovery. Discussion: Respondents believed that full recovery could not be said to have been achieved until they stopped medication and had a steady job. The support and care of family and friends were also vital, although sometimes problematic. Independent living has a different meaning in Chinese culture. Conclusions: Further research directions are suggested as well as ways to change attitudes to the inclusion of medication in recovery. Key words: cultural differences, long term, recovery, schizophrenia

Abstract Prepulse inhibition (PPI) is the reduction in the startle response caused by a low intensity non-startling stimulus (the prepulse) which is presented shortly before the startle stimulus and is [...]

Background: During a four-month period, the authors provided group psychotherapy combining psychodynamic, supportive and psycho-educational approaches. The aim was to investigate whether this approach would enable parents of patients with schizophrenia to re-establish their psychic balance and the balance of the whole family system by reducing high expressed emotion. Methods: The following tools were administered: a socio-cultural questionnaire, MMPI and PIE psychological tests and two questionnaires for group evaluation. Results: The socio-cultural questionnaire showed that the group of parents is heterogeneous. MMPI profiles showed truthful answers and well organized thinking; there were no psychopathological symptoms. The PIE test showed increased dimensions of sociability and trust. The dimensions of fear, sorrow and anger were decreased. Combinations of primary emotions (marked sociability and high self-protection) show that the parents are cautious, responsible and tend to feel guilt. The parents evaluated the group work as interesting and helpful and the group as a place where the parents can overcome the stigma of the disease that affects them, get information, find help and friends and find a way out of their social isolation. Conclusion: This combined approach changes the emotional profile of parents, reduces high expressed emotions (fear, sorrow and anger) in parents and helps re-establish their psychic balance and the balance of the whole family system.

Background: Schneiderian first rank symptoms are included in the most influential operative diagnostic criteria, such as the ICD-10 and the DSM-IV. Many studies have examined their prevalence in the West, but their prevalence in non-Western countries still needs to be explored given that cultural beliefs are so different. Aims: The aim of this study is to shed some light on Schneiderian first rank symptoms (FRS) as they occur in patients with schizophrenia in Egypt. Method: Forty-two patients were interviewed, their demographic characteristics studied and FRS elicited. The SPSS computer program was used to analyse the data. Results: The prevalence rate of FRS was found to be 67%, which is similar to previous studies both in the East and the West. The study also showed that demographic variables had no significant relation to the prevalence of FRS except for nationality and social status. Conclusion: Schneiderian first rank symptoms transcend cultural barriers. However, strong cultural beliefs about the influence of supernatural forces on humans should nonetheless be carefully considered in eliciting delusions of control, influence or passivity.

While research has steadily begun to explore thoughts and beliefs linked with helplessness and despair in schizophrenia, it is less clearly understood how to account phenomenologically for the related experience of being unable to commit to action in the midst of grave discomfort. To explore this issue, the current paper presents an analysis of the experience of volitional paralysis of two persons over the course of long-term integrative psychotherapy. In particular, we explore the experience of the inability to commit to action and the consequences of the gradual recovery of a sense that one is capable of action. Results suggest that in both cases inaction was tethered to a sense of self as insufficiently centered to survive action. In particular, we suggest both men appeared initially unable to commit to action because such a commitment threatened them with forces both felt would undo the tenuous conversations that comprised their identities. Finally, as a sense of self as capable of action emerged, both men began to experience themselves as relatively more complex human beings and to sustain more complex conversation within themselves and between themselves and others. Implications for psychotherapy and rehabilitation are discussed.

Aims: This article investigates the subjective experience of the process of improvement and recovery from the point of view of persons diagnosed (according to research diagnostic criteria) with schizophrenia and schizo-affective disorders. Methods: A community study of persons using psychiatric services was conducted for a sample of ninety subjects taking atypical antipsychotic medications. Sociodemographic data and clinical ratings were collected to complement the qualitatively developed Subjective Experience of Medication Interview (SEMI), which elicits narrative data on everyday activities, medication and treatment, management of symptoms, expectations concerning recovery, stigma, and quality of life. Results: Recovery was observed through: (1) relatively low ratings of psychiatrically observed symptomatology through BPRS scores; (2) the subjective sense among the majority (77.4%) of participants that taking medication plays a critical role in managing symptoms and avoiding hospitalization; and (3) the subjective sense articulated by the vast majority (80%) that they would recover from their illness and that the quality of their lives would improve (70.6%). Conclusion: The overall quality of improvement and recovery is best characterized as an incremental, yet definitively discernable, subjective process.

Smoking rates among persons with schizophrenia are up to three times the rates of the general US population, and research has shown that it is difficult to design cessation programs for people with schizophrenia that take into account their various cognitive and social deficits. More research is needed on the attitudes and priorities of people with schizophrenia in order to design and implement effective smoking cessation programs. Additionally, more research should be conducted with first-episode psychosis and chronic schizophrenia patients to investigate possible differences between these two groups. The purpose of this study, conducted in Atlanta, USA, was to use qualitative methodology to assess the Transtheoretical Model (TTM) in the context of smoking behavior in a sample of participants with schizophrenia-spectrum disorders. Data were obtained via interviews with 12 participants with either first-episode or chronic schizophrenia-spectrum disorders who smoked cigarettes. Differences between the two subsets of the sample were assessed. Results clustered into the following prevalent themes: (1) pros and cons of smoking; (2) beliefs about smoking cessation; (3) external influences on smoking and quitting; and (4) negative attitudes toward nicotine replacement therapies (NRT). Findings indicate that the majority of participants were in the precontemplation stage of quitting smoking, and that the primary advantages of smoking for this sample were relief from anxiety and negative symptoms. Important differences were found between chronic and first-episode participants in the areas of readiness-to-quit and beliefs about smoking cessation. Other findings indicate a lack of cessation programs offered to this sample, and overall negative attitudes toward NRT. Future interventions should take into account the reported pros and cons of smoking in this population, as well as other beliefs and attitudes regarding smoking behavior. Keywords: First-episode psychosis; Schizophrenia; Smoking cessation; Transtheoretical model; USA

Objectives: To study the patterns of readmission in Singapore using a cohort of first admission schizophrenia patients to the state mental health institute. Methods: A retrospective analysis of case records was done of first admission schizophrenia patients to the hospital from April 1993 to March 1994. Patients who had only one admission in the five years of follow up were compared to 'revolving door patients'. Results: The cohort comprised 133 males (56.8%) and 101 females (43.2%). Seventy-eight patients (33.3%) had one admission to the hospital while 56 (23.9%) fulfilled the revolving door criteria. On performing a logistic regression we found sex (p = 0.02), shorter duration of illness (p = 0.01) and CPN referral (0.006) were significantly associated with revolving door phenomena. Conclusions: Our study has identified male gender, history of self-harm and a short duration of illness to be risk factors for 'revolving door' phenomena. Key words: community care, rehospitalisation, revolving door, schizophrenia

Previous studies have indicated a robust link between relatives' causal attributions and levels of expressed emotion (EE). However, these studies have primarily been conducted in Western cultures. The current study, conducted in China, examined the spontaneous causal attributions made by 54 relatives of schizophrenia patients during the Camberwell Family Interview. Chinese relatives made few controllable and personal attributions overall. Yet as predicted, highly critical and/or hostile EE relatives attributed patients' negative behaviors to more controllable and personal factors. High EE and controllable attributions positively predicted relapse, whereas personal attributions unexpectedly protected against relapse. EE mediated the effect of controllable, but not personal, attributions on relapse. Relatives' use of a particular Chinese characteristic (narrow-mindedness) was integral to the personal dimension's protective effect.

Byline: T. V. Chernigovskaya (1), S. E. Davtian (1), N. N. Petrova (1), K. N. Strel'nikov (2) Abstract: The interhemispheric interactions in perception of Russian prosody were studied in the norm and in schizophrenia as a clinical model of impaired hemispheric interactions. Monaural presentation of stimuli and binaural presentation in a free acoustical field were used. Sentences with main variants of Russian prosodic intonations were used as stimuli. The response time and the number of erroneous responses were recorded. In binaural listening without headphones, no significant difference in the percent of errors in identifying the emotional prosody was found between healthy subjects and schizophrenics. Compared with the healthy subjects, the patients made more errors in understanding the logical stress and fewer errors in understanding the syntagmatic segmentation. By response time, a significant dominance of the left ear was revealed in the healthy subjects during monaural listening to sentences with emotional prosody and complete or incomplete sentences, whereas no significant ear dominance was found in the schizophrenics. During monaural listening to sentences with logical stress, the response time was shorter when stimuli were presented to the right ear both in the healthy subjects and in the schizophrenics. The results testified that the functional brain asymmetry in schizophrenics is flattened. The flattening was less evident in the perception of a logical stress in a sentence and did not significantly affect the efficiency of identification of emotional prosody and syntagmatic segmentation of a sentence. Author Affiliation: (1) St. Petersburg State University, St. Petersburg, 199034, Russia (2) Institute of the Human Brain, Russian Academy of Sciences, St. Petersburg, 197022, Russia Article History: Registration Date: 09/10/2004

Expressed emotion is a measure of an individual's critical and/or emotionally overinvolved attitudes toward another person. The characteristics of parents who are high in expressed emotion are not fully understood. This study examined some variables potentially associated with expressed emotion, as measured by the Camberwell Family Interview, in 54 parents of schizophrenic young adults. Statements of (1) self-blame for the patient's illness, (2) controlling behaviors toward the patient, and (3) controlling behaviors toward others were assessed. As predicted, parents who blamed themselves for the patient's illness had higher emotional overinvolvement ratings than non-self-blaming parents. Measures of controlling behavior revealed that highly critical parents were not more controlling than less critical parents; however, parents high in emotional overinvolvement reported higher levels of patient- and other-controlling behaviors than parents low in emotional overinvolvement. These results suggest that the emotional overinvolvement component of high expressed emotion is associated with self-blaming attributions and controlling behaviors in parents, but that the criticism component is not.

This study examines University of Pennsylvania Smell Identification Test (UPSIT; R. L. Doty, 1995) performance in 133 controls and 54 chronic, medicated outpatients with schizophrenia (SZ) using item-response theory modeling. Results show that UPSIT items contribute to 1 factor, cover a range of 8 standard errors of measurement, and articulate 3 ability levels. Although it is not difficult enough to discriminate among persons of above-average ability, the test has diagnostic utility in detecting moderate impairment, Independent of item difficulty, 13 items differentiate patients from controls. When 45 patients and 45 controls were matched on gender and age, patient accuracy remained significantly reduced. The findings support the test's utility and demonstrate how traditional data analysis is insensitive to complexities in test performance.

This study examined family interactions associated with a failure to stabilize in schizophrenia. Fifty-eight patient and parent dyads completed a problem-solving task soon after an acute episode. Stabilization was assessed over the following 6 months. African American patients' self-initiated discussions of substance use and increased anxiety during the interaction were associated with a failure to stabilize. Nonstabilization in White patients was associated with high levels of both the patients' odd thinking and the parents' criticism. White patients who were depressed during the interaction were also less likely to stabilize. Findings suggest that family relationships may play an important role in determining whether patients stabilize after an acute episode. Results also point to the importance of cultural factors in predicting patient stabilization.

Byline: I. S. Lebedeva (1), V. A. Orlova (1), N. Yu. Savvateeva (1) Author Affiliation: (1) National Mental Health Research Center, Russian Academy of Medical Sciences, Kashirskoe sh. 34, Moscow, 115522, Russia Article History: Registration Date: 11/10/2004

Studies of affective experience are guided by the assumption that the structure of affect generalizes across people. Yet this assumption has not been tested among educationally and economically diverse community residents or among individuals with psychopathology. This study explicitly examined the broad applicability of the valence-arousal circumplex and whether schizophrenia patients and nonpatients have comparable knowledge structures of affective phenomena. Patients and nonpatients completed similarity ratings of 120 pairs of affect words. Similarity judgments were analyzed separately for each group using a multidimensional scaling procedure, and solutions were compared. Results revealed the same two-dimensional valence-arousal solution for schizophrenia patients and nonpatients, although there were subtle differences between the groups. These findings provide additional evidence that the circumplex model is a useful formalism for representing affective phenomena across diverse populations, and they bolster confidence in existing interpretations of schizophrenia patients' reports of affective experience.

Byline: I. S. Lebedeva (1), V. A. Orlova (1) Abstract: The subjects were parents, siblings, and children of schizophrenic patients. Auditory evoked potentials (EPs) (P300) were recorded in the standard oddball paradigm with a probability of the target stimuli presentation of 0.2 and sound (tone) intensity of 60 dB. A comparison of these data with the results of the examination of reference groups (normal subjects free of a family history of mental pathology) showed significantly longer latent periods of N1, N2, and P3 in EPs to target stimuli in siblings and children of schizophrenic patients, as well as significantly decreased amplitudes of N1 and P2 in EPs to nontarget (standard) stimuli and longer latent periods of N2 in EPs to target stimuli in the parents of schizophrenic patients. Author Affiliation: (1) Research Center for Mental Health, Russian Academy of Medical Sciences, Moscow, Russia Article History: Registration Date: 16/10/2004

As part of a Nordic multi-centre study investigating the life and care situation of community samples of schizophrenic patients the aim of the present part of the study was to examine the relationship between global subjective quality of life and objective life conditions, clinical characteristics including psychopathology and number of needs for care, subjective factors such as satisfaction with different life domains, social network, and self-esteem. A sample of 418 persons with schizophrenia from 10 sites was used. The results of a final multiple regression analysis, explaining 52.3% of the variance, showed that five subjective factors were significantly associated with global subjective quality of life, together with one objective indicator, to have a close friend. No clinical characteristics were associated with global subjective quality of life. The largest part of the variance was explained by satisfaction with health, 36.3% of the variance, and self-esteem, 7.3% of the variance. It is concluded that the actual relationship between objective life conditions and subjectively experienced quality of life still remains unclear. Furthermore, it seems obvious that personality related factors such as self-esteem, mastery and sense of autonomy also play a role in the appraisal of subjective quality of life, which implies that factors like these are important to consider in clinical and social interventions for patients with schizophrenia in order to improve quality of life for these persons.

Seasonality of birth patterns is examined among a sample of 801 patients with schizophrenia separated into Type I and Type II schizophrenia. Findings indicate that both groups of patients were in utero during the winter but during different trimesters. Patients with Type I schizophrenia were more likely to be in utero during the third trimester. Patients with Type II schizophrenia were more likely to have been in the womb during the first trimester. Implications for fetal brain development are discussed.

Saccadic reaction time (RT) has been shown to be unimpaired in schizophrenia. Could this be due to its not requiring controlled information processing? The authors gave 49 schizophrenia patients and 34 controls manual and saccadic RT tasks with preparatory intervals of 1, 3, and 5 s given in regular and irregular sequences. If saccades require mainly automatic processes, they should not be affected by variations in the preparatory interval that are mediated by controlled processing. The manual task showed typical slower RT and larger preparatory interval effects in patients than in controls. Although the saccadic task showed significant effects of both the preparatory interval and the preparatory interval on the preceding trial similar in kind to those in manual RT, there were no group differences in these or in RT. The results are attributed to greater stimulus-response compatibility in the saccadic task, which puts fewer demands on working memory.

The pregnancy and birth records of 79 schizophrenic patients, from whom adult electrodermal data were available, were systematically evaluated for obstetric complications using 34 criteria of nonoptimality in pregnancy, delivery, and postpartum periods. Patients with many obstetric complications had lower levels of electrodermal activity. For frequency of skin conductance responses and spontaneous fluctuations in skin conductance, the association was more evident for women than for men. However, the ratio of stimulus-elicited to spontaneous skin conductance responses showed a reliable association with obstetric complications without any gender differences. The relationship between obstetric complications and electrodermal activity was interpreted in terms of neurodevelopmental insults resulting in structural brain abnormalities interfering with orienting and electrodermal activity.

The present study reports longitudinal data on individuals who ten years ago were fully recovered from a previously diagnosed schizophrenia. Seven out of ten subjects consented and were reexamined at the present follow-up, and data on an eighth subject was secured elsewhere. A semistructured interview was used to examine psychosocial functioning of the subjects in the follow-up period. Out of the six subjects with a confirmed diagnosis of schizophrenia, only three subjects were still fully recovered; one had a deteriorating course and two had a fluctuating course of illness. The results from the study indicate that recovery from schizophrenia may take the form of time-limited remissions for half of the reexamined subjects when strict criteria for full recovery are used. Protective factors such as willpower, a (partly) intact capacity for object attachment, and a supportive family may be important prerequisites for recovery. Two different courses of schizophrenia are illustrated by cases.

A study assess the impact of smoking on the cognitive deficits of schizophrenia with data from 88 chronic schizophrenic outpatients. The number of cigarettes corresponded to the severity of cognitive symptoms in the Positive and Negative Syndrome scale. Smoking may be helping patients deal with cognitive deficits by increasing the dopaminergic neurotransmission in the brain's prefrontal area.

Schizophrenic patients on neuroleptic medications abuse cocaine and report cocaine-induced euphoria. This study was undertaken to provide better clinical characterization of these phenomena by administering the POMS and a custom-designed questionnaire. A group of heavy cocaine users who were not mentally ill served as the control group. The results clearly suggest that schizophrenic patients report cocaine-induced euphoria and post-use craving despite being treated with therapeutic doses of haloperidol or fluphenazine. The responses of the control group were similar to that of the schizophrenic group except that the latter subjects reported a greater degree of anxiety. These results suggest that blockade of D2 receptors is not sufficient to block cocaine-induced subjective effects in humans. Keywords - human; cocaine abuse; dopamine receptor antagonists.

The effect of display visual angle on span of apprehension (SOA) task performance was investigated in patients with schizophrenia and nonpsychiatric individuals. Narrow and wide visual-angle presentations of 3- and 10-letter arrays were compared. Detection rates were significantly higher with narrow than wide visual angle for nonpsychiatric individuals; the performance of those with schizophrenia was stable across visual-angle conditions. Patients with schizophrenia were best discriminated from nonpsychiatric individuals in the narrow-angle, 1 0-letter condition. Scanpath analyses, which were based on the pattern of detection rates across different target quadrant locations, suggested that the patients with schizophrenia used a similar number and path of covert scan moves as did the controls. Hypotheses are discussed regarding which of the multiple cognitive processes tapped by the SOA task may be impaired in schizophrenia.

A study shows that groups of schizophrenic patients with alcoholic symptoms require special therapeutic techniques for early detection of disease and better treatments. The patients show considerable improvements by therapeutic treatments, coupled with a prohibition on the alcoholic intakes. The study made two sets of random selections to observe the differences in the courses of the disease.

Science has finally caught up with the fact that literary narrative can convey truth more strongly by arousing the reader's power to empathize. Those in the sciences are slowly recognizing the fact that the genre 'scientific writing,' in representing empirical reality is as selective and as partial fiction and that its verity is as 'questionable.' 'Interviewing Eddie,' written in fictive style, recreates the situation for the reader by allowing the characters to speak and by giving them corporeality. It takes the reader to the space and time in which the situation took place. This sense of 'being there' results in greater empathy and perceptual clarity.

The development of a psychometric tool to measure self-efficacy in schizophrenics is described. The self-efficacy scale, which assesses the schizophrenics' behavior and motivational factors, is found to be experimentally valid and statistically reliable. The methodology of the self-efficacy scale is discussed.

The effectiveness of contingent monetary reinforcement and enhanced instruction in modifying apprehension performance span in chronic schizophrenia inpatients was examined. Results revealed that the combination of both intervention approaches was more effective in enhancing patient performance, compared to using each approach by its lonesome or to repeated practice. Patients who underwent the combined approach managed to maintain high levels of performance for as long as one week following the intervention.

Analysis of transcripts from families of schizophrenic patients using the Patient Symptom Profile revealed that patients in high-expressed emotion (EE) environments tended to exhibit more psychopathology when interacting with family members. Results also demonstrated that in high-EE families, relatives tended more to criticize the unusual thoughts of patients, who tend to respond in turn by expressing another unusual thought.

The immunoreactivity of the embryonic highly polysialylated isoform (PSA) of neural cell adhesion molecule (NCAM) is lowered in schizophrenic hippocampi. A reversed plasticity of this isoform is observed in the major portion of the schizophrenic brains. Immunoreactivity is initially noticed in the dentate gyrus and in a subset of cells in the hilus region when immunohistochemical study is performed by using monoclonal antibody identifying the PSA-NCAM.

The high Whitaker's Index of Schizophrenic Thinking (WIST) schizophrenics patients have low accuracy for shame and joy recognition. The study of the extent of thought disorder in schizophrenics involved recognitions of expressions of joy and shame with most variation in recognition of the expression of joy. The accuracy, typical rating and reaction time is measured in schizophrenics who are high or low on WIST in depressive and normal controls.

A study conducted on the relationship between deviance and behavior in children is characterized by a variety of factors ranging from parental schizophrenia to effects of maltreatment. Poorer cognitive performance was associated with maladaptive behavior in schizophrenia risk children.

The correlations of symptoms of hysteria with 87 symptoms relevant for diagnosing schizophrenia were examined in a sample of 112 patients (70 women and 42 men whose mean age was 38.1 yr., SD = 9.8) with DSM-III diagnosis of schizophrenia. Hysterical symptoms were recorded in 37.5% of the schizophrenics. No significant relationships (phi coefficients) were found to key symptoms of schizophrenia.

The relationship between emotional expression and experience in selected medication-free schizophrenics were studied to reveal that they are less expressive when watching emotion producing films despite experiencing positive and negative emotions. These results provide evidence for the Bleulerian approach that schizophrenics experience negative and positive emotions which are not expressed.

Saccadic and smooth pursuit eye movements were recorded in three groups of subjects: a schizophrenic group, a non-schizophrenic psychotic patient comparison group, and a normal control group. Schizophrenic subjects demonstrated a greater decrease in saccadic response time than did normal controls in a gap task (when the fixation point was turned off 150 msec before the target appeared). The psychiatric comparison subjects did not differ from normal controls. Further, only schizophrenic subjects demonstrated a relation between smooth pursuit and saccadic eye movement performance, such that subjects with impaired smooth pursuit showed a larger decrease in saccadic response time in the gap task. The relation between performance on the gap task and quality of smooth pursuit and its relevance for a prefrontal deficit hypothesis of schizophrenia are discussed.