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Kanary, Nikolova Jennifer. "Labyrinth psychotica : simulating psychotic phenomena." Thesis, University of Plymouth, 2016. http://hdl.handle.net/10026.1/5509.
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This thesis forms a valuable tool of analysis, as well as an important reference guide to anyone interested in communicating, expressing, representing, simulating and or imagining what it is like to experience psychotic phenomena. Understanding what it is like to experience psychotic phenomena is difficult. Those who have experience with it find it hard to describe, and those who do not have that experience find it hard to envision. Yet, the ability to understand is crucial to the interaction with a person struggling with psychotic experiences, and for this help is needed. In recent years, the psychosis simulation projects Mindstorm, Paved with Fear, Virtual Hallucinations and Living With Schizophrenia have been developed as teaching and awareness tools for mental health workers, police, students and family members, so that they can better understand psychotic phenomena. These multimedia projects aim to improve understanding of what a person in psychosis is going through. This thesis represents a journey into taking a closer look at their designs and comparing them to biographical and professional literature. In doing so, throughout the chapters, a set of considerations and design challenges have been created that need to be taken into account when simulating psychosis. After a series of artistic case study labyrinths, Suicide Pigeon, Intruder, and Intruder 2.0, two final ‘do-it-yourself-psychosis’ projects have been created that have taken the aspects collected into account: The Labyrinth and The Wearable. Together these two projects form experiences that may be considered analogous to psychotic experiences. My original contribution to knowledge lies, on the one hand, within the function that both The Labyrinth and The Wearable have on a person’s ability to gain a better understanding of what it feels like to be in psychosis, and on the other hand within the background information provided on the context and urgency of psychosis simulation, how the existing simulations may be improved, and how labyrinthine installation art may contribute to these improvements.
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Dixon, James Eoin Luke. "The centrality of psychotic experiences and emotional dysfunction following psychosis." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4474/.
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Objective: The first objective of the thesis was to carry out a literature review to critically review the literature on emotion regulation within psychosis populations. The second objective of the thesis was to empirically investigate the concept of centrality in psychosis. Method: For the literature review a systematic search of five databases was carried out with the final selection of quantitative studies evaluated for methodological and theoretical quality. For the empirical part a cross-sectional methodology was employed which used a qualitative analysis of the data collected from fifty participants diagnosed with first-episode psychosis attending an early intervention service. Results: Twenty-one papers met inclusion criteria, with the review identifying emotion regulation strategies that were adaptive and maladaptive to a psychosis population. Results for the empirical research found centrality to be associated with increased post-psychotic depression. Discussion: Methodological and theoretical challenges within the field of emotion regulation were discussed following the literature review. The concept of centrality as applied to a psychosis populations. Clinical implications were drawn out from both parts of the thesis.
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Mannion, Aisling. "Psychosis and psychotic-like experiences in pregnant and postpartum women." Thesis, University of Sheffield, 2013. http://etheses.whiterose.ac.uk/4586/.
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Davies, Daniel Jay. "Psychotic experiences beyond psychotic disorders : from measurement to computational mechanisms." Thesis, University of Cambridge, 2017. https://www.repository.cam.ac.uk/handle/1810/267820.
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Psychotic experiences (PEs) occur in the general population, beyond psychotic disorders. PEs are a risk factor for mental ill health in young people but can occur benignly in selected samples of adults. Environmental factors predispose to PEs but their underlying mechanisms are not well-understood. Progress in understanding PEs may be limited by diverse conceptualisations, imprecise measurement and a lack of explanatory frameworks that can bridge the gaps between aetiological factors, their effects on the brain and their behavioural manifestations. In this thesis, I undertook a comprehensive investigation of the measurement, health implications, aetiology and computational mechanisms of PEs in adolescents and young adults using data from two large cohort samples, supplemented with smaller-scale behavioural studies. I first investigated the measurement of PEs. I assessed and optimised the measurement of PEs in young people by two self-report instruments. I then used latent variable modelling to show that a self-report and interview instrument measured the same underlying psychotic phenomena. Both instruments were able to measure severe PEs, while the self-report questionnaire also measured more mild psychotic phenomena. I then investigated the health implications of PEs. Using cluster analysis in both cohorts, I found replicable patterns of PEs at similar levels of intensity and persistence but with and without depressive symptoms and with varying risk of mental disorder. Paranoid ideation was more associated with depressive symptoms than non-paranoid unusual perceptions and beliefs. Childhood adversity was associated with both PE-prone groups, but later social support from family and friends was far higher in those with PEs and low depressive symptoms than those with PEs and high depressive symptoms. Subsequently, I investigated the role of the social environment in the development of PEs and psychopathology using longitudinal structural equation modelling. I found that asocial dispositions increased or preceded increase in PEs over one year, mediated by detriment to social support. Conversely, PEs did not precede or increase asociality. I then showed that dimensions of PEs and depressive symptoms were promoted by childhood adversity but differentially affected by later social support, with paranoid ideation being more influenced by support than non-paranoid unusual perceptions/beliefs. Finally, I investigated specific mechanisms of PEs in two behavioural studies. In the seventh study, I used computational modelling of reward learning to link PEs to reduced ability to modulate learning by confidence, replicating computational effects of a pharmacological model of psychosis. I also used a novel visual task to show that the manifestation of PEs as anomalous perceptions versus anomalous beliefs might be explained by over-reliance on different types of prior knowledge in perceptual inference. These results suggest that different conceptual approaches to PEs might be synthesised despite issues with their measurement. PEs in young people, while not entirely benign, are heterogeneously associated with psychopathology. Importantly, they characterise a minority of young people who are at very high transdiagnostic risk of mental illness but also occur without distress in young people, often in the context of a supportive social environment. Health outcomes in young people with PEs are predicted and potentially modified by social functioning and social relationships. PEs might arise from atypicalities in how the influences of information sources on perception and belief-updating are modulated according to their reliabilities.
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Harrop, Christopher Edward. "Schizophrenia : adolescent development and self-construction." Thesis, University of Birmingham, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364491.
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Feresten, Abigail Helms. "Astrocytes in psychotic disorder." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/45435.
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Astrocyte dysregulation has been implicated in the pathophysiology of schizophrenia (SCZ) and bipolar disorder (BPD), however the exact nature of astrocytic alterations remains to be identified. I investigated whether levels of four astrocyte-specific proteins; glial fibrillary acidic protein (GFAP), aldehyde dehydrogenase type 1L1 (ALDH1L1), vimentin, and excitatory amino acid transporter type 1 (EAAT1) are altered in SCZ and BPD. Immunohistochemical staining of ALDH1L1 and GFAP in human grey and white matter was also performed, and staining patterns compared qualitatively. Relative concentrations of GFAP, ALDH1L1, vimentin, and EAAT1 were assessed post-mortem in the dorsolateral prefrontal cortex in SCZ (n=35), BPD (n=34) and non-psychiatric control (n=35) groups by western blotting. The same proteins were also quantified in the cingulate cortex of rats administered the antipsychotics haloperidol and clozapine. Elevated levels of GFAP were observed in SCZ and BPD, when compared to controls. GFAP was also significantly increased in individuals with psychotic symptoms, when compared to those without. Vimentin, ALDH1L1 and EAAT1 levels did not differ between groups. Rats exposed to antipsychotics did not exhibit significant overall differences in any astrocytic protein, suggesting that increased GFAP in SCZ is not attributable to antipsychotic treatment. Our findings indicate that astrocyte pathology may be associated with psychotic symptoms. Lack of ALDH1L1 and vimentin variability, paired with increased GFAP levels, may imply that astrocyte numbers are unchanged but astrocytes are partially activated, or may indicate a specific dysregulation of GFAP. Immunohistochemical results suggest that ALDH1L1 may be a more reliable marker of astrocytes than GFAP in human grey matter.
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Plaistow, James. "Exploratory study of psychological risk factors for post-psychotic depression in early psychosis." Thesis, University of East Anglia, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.393305.
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Prentice, Wendy. "Psychotic and non psychotic interpretations of physiological sensations in delusional, panic, and healthy populations." Thesis, University of Edinburgh, 2008. http://hdl.handle.net/1842/25095.
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It has been suggested that people with psychosis as well as people with panic disorder experience similar internal experiences (thoughts, emotions, body state information) but interpret them in different ways. This study seeks to explore the extent to which individuals who experience delusions and those who experience panic are similar in terms of their interpretations of common somatic symptoms and to explore other factors which have been implicated in causing and maintaining delusions. This has implications for the further understanding and treatment of delusions. This study used a between groups design and was based on an opportunity sample of inpatients in a psychiatric ward and out patients attending clinical psychology and psychiatry departments. Three groups of participants were recruited for this study which included 16 people who were experiencing delusions, 11 people who were experiencing panic disorder, and 15 healthy individuals who have no previous history of mental health problems. The participants filled in self-report questionnaires measuring somatic attributions; metacognitions; experiential avoidance; state/trait anxiety; delusion proneness; self-esteem and emotionality. Significant differences were found between the clinical groups and the healthy control group on scores for all 7 measures, supporting the hypotheses regarding the similarities between the clinical groups, although there is partial support for the idea that the clinical groups interpreted somatic symptoms differently; however, this is tentative. Overall, the results provide support for the continuum model of psychosis and Morrison’s theory that people who experience panic and those who experience delusions process internal events in a similar way. These results also inadvertently suggest that anomalous internal experiences may be necessary in order for delusional beliefs to occur.
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Escher, Alexandre Dorothée Marie Adrienne Charlotte. "Making sense of psychotic experiences." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 2005. http://arno.unimaas.nl/show.cgi?fid=6049.
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Cunningham, Twylla. "Investigating trauma and psychotic experience." Thesis, Queen's University Belfast, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.695322.
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A systematic review of the literature was conducted to ascertain whether or not childhood bullying predicts the later development of psychotic symptoms. A meta-analysis and review of ten prospective studies suggests that this is the case. What is lacking from the literature, is adequate investigation into other potential mediating factors that contribute to some of the variance. The current review serves to highlight the significant role of bullying within this complex interaction. Potential influencing mediators are explored, including a dose-response effect for the severity and frequency of victimization. Suggestions for targeting intervention are also suggested alongside clinical implications and recommendations for future research. The first empirical paper compared rates of self-reported trauma with that which was recorded in patients' case notes. High levels of lifetime, childhood and Troubles-related trauma were reported within a psychosis sample. As expected, large discrepancies were noted. In line with similar studies, the results suggest that mental health practitioners continue to be reluctant to enquire about trauma histories with this population and as a result, case notes extensively underestimate the prevalence rates of trauma. The second empirical paper asked people with psychosis about their perspective with regards to participating in trauma-related research. The results suggest that enquiring about trauma within a psychosis population does not cause considerable distress and that a significant majority participants also report, in line with previous research, favourable views on the importance of such even if they do find it somewhat difficult.
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Spauwen, Janneke, Lydia Krabbendam, Roselind Lieb, Hans-Ulrich Wittchen, and Os Jim van. "Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-108608.
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Background. The reported link between psychological trauma and onset of psychosis remains controversial.
Aims. To examine associations between self-reported psychological trauma and psychotic symptoms as a function of prior evidence of vulnerability to psychosis (psychosis proneness).
Method. At baseline, 2524 adolescents aged 14-24 years provided self-reports on psychological trauma and psychosis proneness, and at follow-up (on average 42 months later) participants were interviewed for presence of psychotic symptoms.
Results. Self-reported trauma was associated with psychotic symptoms, in particular at more severe levels (adjusted OR1.89,95% CI1.16-3.08) and following trauma associated with intense fear, helplessness or horror. The risk difference between those with and without self-reported trauma at baseline was 7% in the group with baseline psychosis proneness, but only 1.8% in those without (adjusted test for difference between these two effect sizes: χ2=4.6, P=0.032).
Conclusions. Exposure to psychological trauma may increase the risk of psychotic symptoms in people vulnerable to psychosis.
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Spauwen, Janneke, Lydia Krabbendam, Roselind Lieb, Hans-Ulrich Wittchen, and Os Jim van. "Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness." Technische Universität Dresden, 2006. https://tud.qucosa.de/id/qucosa%3A26761.
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Background. The reported link between psychological trauma and onset of psychosis remains controversial.
Aims. To examine associations between self-reported psychological trauma and psychotic symptoms as a function of prior evidence of vulnerability to psychosis (psychosis proneness).
Method. At baseline, 2524 adolescents aged 14-24 years provided self-reports on psychological trauma and psychosis proneness, and at follow-up (on average 42 months later) participants were interviewed for presence of psychotic symptoms.
Results. Self-reported trauma was associated with psychotic symptoms, in particular at more severe levels (adjusted OR1.89,95% CI1.16-3.08) and following trauma associated with intense fear, helplessness or horror. The risk difference between those with and without self-reported trauma at baseline was 7% in the group with baseline psychosis proneness, but only 1.8% in those without (adjusted test for difference between these two effect sizes: χ2=4.6, P=0.032).
Conclusions. Exposure to psychological trauma may increase the risk of psychotic symptoms in people vulnerable to psychosis.
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Hides, Leanne, and n/a. "An Examination of the Influence of Cannabis Use on Psychotic Symptom Exacerbation and Relapse in Early Psychosis." Griffith University. School of Applied Psychology, 2003. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20030922.130049.
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There has been concern about the impact of cannabis use on the onset, course and relapse of psychosis. Evidence from retrospective and a small number of prospective studies has suggested that cannabis use may precipitate a latent psychosis, exacerbate psychotic symptoms and increase the likelihood of psychotic relapse. The purpose of the current study was to examine the influence of cannabis use on psychotic symptom exacerbation and relapse within the stress vulnerability-coping model of psychosis. Two studies were conducted. The influence of cannabis use on the onset and course of psychosis was retrospectively examined in the first study. The second study prospectively examined the influence of cannabis use on psychotic symptom exacerbation and relapse over a 6-month period. The influence of the severity of psychotic symptoms on a relapse in cannabis use was also explored. Eighty-four participants were assessed at admission, 81 of whom were followed up for a 6-month period. Measures consisted of structured diagnostic interviews and self-report measures of stress, medication compliance, family functioning, premorbid adjustment, quality of life, substance use and psychotic symptoms. The onset of cannabis use clearly preceded the onset of psychosis. Cannabis use was predictive of the severity of psychotic and general psychopathology symptoms at admission. Both the frequency and quantity of cannabis use was predictive of time to psychotic relapse over the 6-month follow up period. Psychotic symptom severity was predictive of a substantial increase in the quantity but not the frequency of cannabis use. Cannabis use was related to the onset, course and relapse of psychosis.
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Henquet, Cécile, Lydia Krabbendam, Janneke Spauwen, et al. "Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-120761.
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Objective: To investigate the relation between cannabis use and psychotic symptoms in individuals with above average predisposition for psychosis who first used cannabis during adolescence.
Design: Analysis of prospective data from a population based sample. Assessment of substance use, predisposition for psychosis, and psychotic symptoms was based on standardised personal interviews at baseline and at follow up four years later.
Participants: 2437 young people (aged 14 to 24 years) with and without predisposition for psychosis.
Main outcome measure: Psychotic symptoms at follow up as a function of cannabis use and predisposition for psychosis at baseline.
Results: After adjustment for age, sex, socioeconomic status, urbanicity, childhood trauma, predisposition for psychosis at baseline, and use of other drugs, tobacco, and alcohol, cannabis use at baseline increased the cumulative incidence of psychotic symptoms at follow up four years later (adjusted odds ratio 1.67, 95% confidence interval 1.13 to 2.46). The effect of cannabis use was much stronger in those with any predisposition for psychosis at baseline (23.8% adjusted difference in risk, 95% confidence interval 7.9 to 39.7, P = 0.003) than in those without (5.6%, 0.4 to 10.8, P = 0.033). The risk difference in the “predisposition” group was significantly greater than the risk difference in the “no predisposition” group (test for interaction 18.2%, 1.6 to 34.8, P = 0.032). There was a dose-response relation with increasing frequency of cannabis use. Predisposition for psychosis at baseline did not significantly predict cannabis use four years later (adjusted odds ratio 1.42, 95% confidence interval 0.88 to 2.31).
Conclusion: Cannabis use moderately increases the risk of psychotic symptoms in young people but has a much stronger effect in those with evidence of predisposition for psychosis.
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Henquet, Cécile, Lydia Krabbendam, Janneke Spauwen, et al. "Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people." Technische Universität Dresden, 2004. https://tud.qucosa.de/id/qucosa%3A27119.
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Objective: To investigate the relation between cannabis use and psychotic symptoms in individuals with above average predisposition for psychosis who first used cannabis during adolescence.
Design: Analysis of prospective data from a population based sample. Assessment of substance use, predisposition for psychosis, and psychotic symptoms was based on standardised personal interviews at baseline and at follow up four years later.
Participants: 2437 young people (aged 14 to 24 years) with and without predisposition for psychosis.
Main outcome measure: Psychotic symptoms at follow up as a function of cannabis use and predisposition for psychosis at baseline.
Results: After adjustment for age, sex, socioeconomic status, urbanicity, childhood trauma, predisposition for psychosis at baseline, and use of other drugs, tobacco, and alcohol, cannabis use at baseline increased the cumulative incidence of psychotic symptoms at follow up four years later (adjusted odds ratio 1.67, 95% confidence interval 1.13 to 2.46). The effect of cannabis use was much stronger in those with any predisposition for psychosis at baseline (23.8% adjusted difference in risk, 95% confidence interval 7.9 to 39.7, P = 0.003) than in those without (5.6%, 0.4 to 10.8, P = 0.033). The risk difference in the “predisposition” group was significantly greater than the risk difference in the “no predisposition” group (test for interaction 18.2%, 1.6 to 34.8, P = 0.032). There was a dose-response relation with increasing frequency of cannabis use. Predisposition for psychosis at baseline did not significantly predict cannabis use four years later (adjusted odds ratio 1.42, 95% confidence interval 0.88 to 2.31).
Conclusion: Cannabis use moderately increases the risk of psychotic symptoms in young people but has a much stronger effect in those with evidence of predisposition for psychosis.
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Pinacho, Garcia Raquel. "SP Transcription factors in psychotic disorders." Doctoral thesis, Universitat de Barcelona, 2015. http://hdl.handle.net/10803/327025.
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Psychotic disorders including bipolar disorder and schizophrenia are a leading cause of disability across the world but the underlying pathophysiological mechanisms remain poorly understood. Available treatments are inadequate for some sets of symptoms as is the case for negative symptoms in schizophrenia. Alterations in brain connectivity, synaptic plasticity, N-methyl D aspartate receptor (NMDAR) signalling and calcium homeostasis have been suggested to contribute to these disorders. However, the particular transcriptional programmes altered in these disorders are not fully characterised. Previous data suggested that the transcription factors specificity protein 4 (SP4) and SP1 may be involved in the pathophysiology of psychotic disorders. We hypothesized that the expression and/or function of SP4 and SP1 may be altered in psychotic disorders through the regulation of transcriptional programmes involved in neuronal patterning, synaptic plasticity and glutamate signalling. In this doctoral Thesis we aimed to characterise the contribution of SP4 and SP1 transcription factors to the pathophysiology of psychotic disorders. By using real time quantitative RT-PCR and/or immunoblot techniques, we analysed the expression of SP factors, of SP4 S770 phosphorylation and/or of selected SP-regulated gene targets in at least one of the following substrates: (i) rat cerebellar granule neurons (CGNs), (ii) the postmortem brains of bipolar disorder, schizophrenia and control subjects, (iii) peripheral mononuclear blood cells (PMBC) of first-episode psychosis, and (iv) the rodent hippocampus after NMDAR blockade and antipsychotic treatment.
We found that membrane depolarisation regulates SP4 protein levels in CGNs by preventing SP4 degradation via the ubiquitin-proteasoma pathway and that lithium prevents SP4 degradation and increases SP1 gene expression in non-depolarising conditions. In postmortem human tissue, we found a reduction in protein but not mRNA expression of SP4 and SP1 in the cerebellum in subjects with bipolar disorder and in subjects with more severe negative symptoms in schizophrenia. We have also found reduced expression of protein and mRNA levels of SP4 in the prefrontal cortex in bipolar disorder and of SP1 in the same region in schizophrenia, suggesting a disorder-specific regulation in this area. In contrast, both SP4 and SP1 protein and mRNA levels were increased in the hippocampus in schizophrenia. Consistent with this, we also observed an increase of SP1 and SP4 protein levels in the hippocampus of a mouse model of psychosis, but not in the hippocampus of a rat model of chronic antipsychotic treatment, suggesting that this upregulation may be present from the early stages of psychosis.
We further characterised the phosphorylation of SP4 at serine 770 (S770), which is regulated by membrane depolarisation and NMDAR activity. We found an increase of SP4 S770 phosphorylation in conditions where SP4 protein levels are reduced, namely in the cerebellum of bipolar disorder and of schizophrenia patients with more severe negative symptoms, as well as in PMBC in first-episode psychotic patients. These results suggest that an imbalance in SP4 abundance may be regulated by NMDAR-dependent SP4 phosphorylation in the brain. Moreover, we found that reduced expression of NR2A and DRD2 in the cerebellum of schizophrenia patients correlated with more severe negative symptoms and SP protein levels. Additionally, we show here evidence for an imbalance in the SP4-NWK2-NR1 pathway in the cerebellum of patients with bipolar disorder. This pathway is involved in NR1 subunit availability on the cell surface, suggesting that SP4 could contribute to altered NR1 receptor trafficking in psychotic disorders.
Together, the results presented in this Thesis suggest an imbalance in SP4 and SP1 transcription factors in the brains of patients with bipolar disorder and schizophrenia that may contribute to alterations in NMDAR receptor signalling and thereby to the impaired synaptic plasticity and altered brain connectivity observed in psychotic disorders.
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Wilson, Alistair. "A neurophysiological study of psychotic disorder." Thesis, Queen's University Belfast, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335263.
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Papada, Peggy. "Understanding women's experiences of psychotic phenomena." Thesis, Canterbury Christ Church University, 2013. http://create.canterbury.ac.uk/12502/.
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Psychotic phenomena such as delusions have recently been understood as meaningful within the context of a person’s life while recent models of psychosis implicate psychosocial influences in its aetiology. Research on women with such experiences has been limited despite recognition of their specific needs and vulnerabilities due to the nature of their lives. This study aimed to examine the processes influencing women’s understandings of their delusional beliefs in the context of their lives. It used a social constructionist version of grounded theory to conceptualize the process of women’s understandings. Ten women who had experienced delusions were interviewed. Grounded theory analysis revealed four main processes: women’s acquisition of knowledge about themselves; significant life experiences; how women experience their delusions; and the process of emerging from the delusional world. According to the constructed theory, the core process of understanding is conceptualized as residing in the space between private experience and the social world. It is mediated by the relationship women have to knowledge about the self, which in turn is mediated by the responses of others. Delusions are understood as responses to life experiences and are therefore meaningful containers of truth. Implications for clinical practice, limitations and suggestions for further research are discussed
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Sandt, Arthur Ralph. "Hedonic Functioning and Subthreshold Psychotic Symptoms." Diss., Temple University Libraries, 2013. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/164124.
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Psychology<br>Ph.D.<br>Schizophrenia is a debilitating disorder with an array of affective, cognitive, and behavioral consequences. In addition to these impairments, research suggests that there is a distinct pattern of hedonic functioning in schizophrenia that may contribute to some of the most intractable symptoms of the disorder, the negative symptoms. Specifically, individuals with schizophrenia appear to experience deficient levels of pleasure during anticipation of a pleasurable stimulus, while experiencing typical levels of pleasure while directly engaged with a pleasurable stimulus. Despite these findings, it is unclear whether hedonic functioning deficits occur in individuals with subthreshold levels of psychotic symptoms and/or in individuals at clinical high risk for the disorder. The purpose of this study was to examine hedonic functioning in relation to the continuum of psychotic symptoms in a college undergraduate student sample, and in those at clinical risk for schizophrenia. Participants were 679 students who completed self-report measures of current psychotic-like experiences, and trait-like components of hedonic functioning (i.e., anticipatory and consummatory pleasure). Consistent with study hypotheses, deficits in anticipatory pleasure, but not in consummatory pleasure, were significantly associated with increased clinical risk for schizophrenia. However, this relation was found exclusively among women in the sample, whereas men did not show a significant relation between anticipatory pleasure deficits and clinical high-risk. Furthermore, anticipatory pleasure deficits were not significantly associated with increases in the number of positive psychotic symptoms endorsed. Moreover, consummatory pleasure was not associated with increases in the number of subthreshold positive psychotic symptoms, nor was there a relation with the number of distressing positive psychotic symptoms or clinical risk status. The present study provides the first examination of the relation between hedonic functioning and subthreshold psychotic symptoms, as well as the relation with clinical high-risk for psychosis. These findings suggest that anticipatory pleasure deficits may be more closely related to increased clinical risk for psychosis among women rather than increases in psychotic symptoms in the general population. Anticipatory pleasure deficits may be a useful target for intervention and prevention techniques among those at clinical risk for psychosis, especially in female at risk populations. Additional longitudinal studies will be essential for testing whether anticipatory pleasure deficits predict the occurrence of future psychotic disorders among those at high risk for the disorder in order to improve early identification and early intervention efforts in this population.<br>Temple University--Theses
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Duffin, S. "Chronic ketamine use and psychotic symptomatology." Thesis, University College London (University of London), 2008. http://discovery.ucl.ac.uk/1445229/.
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This thesis examines the effects of chronic use of ketamine, a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, on subjective experience and cognition. It is important to explore the chronic effects of ketamine as the number of individuals using the drug recreationally is increasing both in the UK and worldwide. There is a paucity of research exploring the chronic effects of ketamine. Many studies have shown that acutely ketamine induces psychotic-like symptomatology and specific cognitive dysfunction in healthy, drug-naive volunteers. For this reason, a ketamine model of the psychoses has been proposed. However the few studies of the effects of chronic ketamine have provided mixed findings. Part 1 of the thesis comprises a literature review, which investigates the psychotomimetic effects of ketamine, through the synthesis of current research findings, to determine whether ketamine is a useful model of the symptomatology characteristic of the psychoses. It presents an overview of ketamine and its association with the psychoses, before providing a detailed account of the functional psychoses and drug models of the psychoses (namely the dopamine hypothesis, the serotonin hypothesis and the glutamate hypothesis). The review then synthesises the acute and chronic ketamine studies to date, highlighting which states appear to be best modelled (i.e. the pre-psychotic, acute or chronic state experienced by individuals with idiopathic psychoses). Finally, the review briefly considers the treatment implications of the ketamine model of psychoses, and the risk chronic ketamine use poses to users in terms of developing fully-manifest psychotic symptomatology. In Part 2, an investigation of the chronic effects of ketamine on subjective experiences and cognitive functioning is reported, in order to determine whether chronic ketamine models symptomatology associated with the pre-psychotic state of idiopathic psychoses (where the term idiopathic refers to psychotic symptomatology of unknown aetiology, i.e. that which occurs in the majority of the general population and is not drug-induced). This investigation was part of a joint project conducted with 2 other trainees to investigate the chronic effects of ketamine, cannabis and cocaine on subjective experiences and cognitive functioning (See Appendix 1 for details of the contribution made by each trainee). The empirical paper reports a between subjects study which compared 21 frequent ketamine users (who used ketamine daily), 20 infrequent ketamine users (who used ketamine a maximum of once or twice a week) and 20 controls (who reported no illicit drug use). On a clinical index of symptomatology (SPI-A), a 'frequency' effect was observed: frequent ketamine users were found to be higher in psychotic-like symptomatology (i.e. basic symptoms) than infrequent users, who in turn were found to be higher in symptomatology than controls. Both groups of ketamine users were also found to be higher in psychosis proneness on a general population index of psychotic-like markers (OLIFE) compared with controls. Furthermore, both groups of ketamine users demonstrated impaired episodic memory and working memory compared to controls. Group differences were found in executive functioning. Part 3 comprises a critical appraisal of the research. It includes reflections on my experience of the research process and conducting research with the ketamine using population, as well as reflections on clinically relevant observations.
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Preston, Neil Joseph. "The causal predominance of psychotic experience." Thesis, Curtin University, 2003. http://hdl.handle.net/20.500.11937/2307.
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The present study investigated the causal predominance of cognition on anxiety, depression, paranoia, phobia and somatic concern over three time waves of self reported data measured every six months over one year, of 145 cases experiencing their first episodes of psychosis. In turn the symptoms of anxiety, depression, paranoia, phobia and somatic concern were examined for their cross-influential effects on cognition. Cognition was examined under a causal predominance hypothesis as the lead symptom because of its influence recognised in the literature under the neurodevelopmental hypothesis. These longitudinal effects were examined using structural equation modelling. Prior to this investigation, the research was able to demonstrate a stable 6-factor measurement model with these symptoms between two independent samples of early psychosis cases that met guidelines of treatment under the Australian national early psychosis treatment guidelines. This measurement model demonstrated good internal reliability and construct validity. Most symptoms over each time wave had a "domino effect" where the symptom prior to the next wave of assessment had an influence. This is known as a mediation effect. Somatic concern and depression demonstrated a "snow ball" or direct effect where the extent of the condition at time one influenced directly the condition at time three. Structural models, which examined the cross-influential effect between cognition and the other symptoms, demonstrated an effect between paranoia and cognition. This effect demonstrated that paranoia at Time 2 (i.e., 6 months after stabilisation of symptoms), had a crossinfluential effect on cognition at Time 3 (ie, 12 months after stabilisation of symptoms).It was argued that poor thinking styles that lead to distortion in feelings of mistrust evident in the paranoia symptom, in turn led to deterioration in cognition. Other symptoms did not demonstrate a cross influential effect. Previous research suggesting that symptoms act independently of each other over time supports the results of independence of the other symptoms. Further research was suggested by linking different levels of psychosis research of the aetiological factors (e.g. genetic factors), neuropathology (e.g., reduced synapse density) and phenomenology (e.g., positive and negative symptoms) into an integrative framework. It was suggested that structural equation modelling as exemplified in the thesis could be used as a technique to examine how these differing levels could be investigated under a unified theory of psychosis based upon the neurodevelopmental hypothesis.
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Preston, Neil Joseph. "The causal predominance of psychotic experience." Curtin University of Technology, School of Psychology, 2003. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=14961.
Full textAbstract:
The present study investigated the causal predominance of cognition on anxiety, depression, paranoia, phobia and somatic concern over three time waves of self reported data measured every six months over one year, of 145 cases experiencing their first episodes of psychosis. In turn the symptoms of anxiety, depression, paranoia, phobia and somatic concern were examined for their cross-influential effects on cognition. Cognition was examined under a causal predominance hypothesis as the lead symptom because of its influence recognised in the literature under the neurodevelopmental hypothesis. These longitudinal effects were examined using structural equation modelling. Prior to this investigation, the research was able to demonstrate a stable 6-factor measurement model with these symptoms between two independent samples of early psychosis cases that met guidelines of treatment under the Australian national early psychosis treatment guidelines. This measurement model demonstrated good internal reliability and construct validity. Most symptoms over each time wave had a "domino effect" where the symptom prior to the next wave of assessment had an influence. This is known as a mediation effect. Somatic concern and depression demonstrated a "snow ball" or direct effect where the extent of the condition at time one influenced directly the condition at time three. Structural models, which examined the cross-influential effect between cognition and the other symptoms, demonstrated an effect between paranoia and cognition. This effect demonstrated that paranoia at Time 2 (i.e., 6 months after stabilisation of symptoms), had a crossinfluential effect on cognition at Time 3 (ie, 12 months after stabilisation of symptoms).<br>It was argued that poor thinking styles that lead to distortion in feelings of mistrust evident in the paranoia symptom, in turn led to deterioration in cognition. Other symptoms did not demonstrate a cross influential effect. Previous research suggesting that symptoms act independently of each other over time supports the results of independence of the other symptoms. Further research was suggested by linking different levels of psychosis research of the aetiological factors (e.g. genetic factors), neuropathology (e.g., reduced synapse density) and phenomenology (e.g., positive and negative symptoms) into an integrative framework. It was suggested that structural equation modelling as exemplified in the thesis could be used as a technique to examine how these differing levels could be investigated under a unified theory of psychosis based upon the neurodevelopmental hypothesis.
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Teferra, Abebe Solomon. "Studies on psychotic disorders in rural Ethiopia." Doctoral thesis, Umeå universitet, Psykiatri, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-43826.
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Background Studies on course and outcome of schizophrenia coming from low income countries are increasingly becoming important to challenge the existing dogma claiming good outcome in these countries. Besides clinical course and outcome, mortality is considered a very important outcome measure for schizophrenia. Culture and tradition play a significant role in the manifestations of severe mental illnesses (SMI). Khat is a culturally accepted plant endemic to Eastern Africa, which is chewed by people for its stimulating effect. It is believed that Khat influences the course and outcome of schizophrenia although systematic studies are scarce. Patients with SMI continue to chew khat despite advice from their doctors to desist. Reasons for this behavior were not fully investigated before. Objectives - To describe the 5-year clinical course and outcome and mortality of schizophrenia in Butajira. - To explore traditional views on psychosis in the semi-nomadic Borana population. - To describe the perceived causes and preferred treatment for SMI in the semi-nomadic Borana population - To explore reasons for khat chewing behavior in people with SMI in Butajira. Methods The studies were done in two sites: Butajira and Borana. The Butajira study involved screening, using CIDI and Key Informants (KIs), of more than 68,000 adults aged 15-49. Of these, 321 people were diagnosed with schizophrenia and were followed-up for five years to look into their clinical course and outcome, including mortality. A qualitative study involving 37 men with SMI and 30 female caregivers was conducted in Butajira to study reasons why patients continue to chew khat despite their physicians’ advice against it. The Borana study of a remote semi-nomadic population in southern Ethiopia, used qualitative methods involving 56 KIs to identify descriptions of psychosis, perceived causes and preferred treatment in the community. Cases identified by the KIs also underwent SCAN interview for confirmatory diagnosis. Results The five year follow-up of schizophrenia patients showed that 45% of participants were continuously symptomatic with 30.3% having had continuous psychotic episode. About 20% had experienced continuous remission. Being single (OR = 3.41, 95% CI = 1.08-10.82, P = 0.037), on antipsychotic treatment for at least 50% of follow up time (OR = 2.28, 95% CI = 1.12-4.62, P = 0.023), and having a diagnosis of paranoid subtype of schizophrenia (OR = 3.68, 95% CI = 1.30-10.44, P = 0.014) were associated with longer period of remission. A total of 38 (12.4%) patients, thirty four men (11.1%) and four women (1.3%) died during the 5-year follow-up period. The mean age (SD) of the deceased for both sexes was 35 (7.35): 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to 7.87): 6.27 (95% C I = 4.16 to 8.38) for men and 4.30 (95% CI = 1.02 to 8.52) for women. Patients residing in rural areas had lower mortality with adjusted HR of 0.30 (95% CI = 0.12-0.69) but those with insidious onset had higher mortality with adjusted HR 2.37 (95% CI = 1.04-5.41). Treatment with antipsychotics for less than 50% of the follow-up time was also associated with higher mortality, adjusted HR 2.66 (1.054-6.72). In the Borana study, the incongruity between local and psychiatric concepts in the CIDI lay mainly in the fact that KIs described characteristics of marata (madness) in terms of overt behavioral symptoms instead of thought disturbances. Following the focus group discussions, participants identified 8 individuals with schizophrenia and 13 with a psychotic mood disorder, confirmed by SCAN interview. Supernatural causes such as possession by evil spirits, curse, bewitchment, ‘exposure to wind’ and subsequent attack by evil spirits in postnatal women; bio-psycho-social causes such as infections (malaria), loss, ‘thinking too much’, and alcohol and khat abuse were mentioned as causes of SMI. The preferred treatments for severe mental illness included mainly traditional approaches, such as consulting Borana wise men or traditional healers, prayer, holy water treatment and, finally, seeking modern health care. Regarding khat and SMI in Butajira, reasons given by patients as well as caregivers were more or less congruent: social pressure, a means for survival by improving function, combating medication side effects, to experience pleasure and curbing appetite. Conclusion Schizophrenia runs a chronic and non-remitting course and was associated with very high premature mortality in Butajira. Continued treatment with antipsychotics has been a consistent predictor of favorable outcome and reduced mortality. Case identification in studies of psychotic disorders in traditional communities are likely to benefit from combining structured interviews with the key informant method. Planning mental health care in traditional communities needs to involve influential people and traditional healers to increase acceptability of modern mental health care. Patients with SMI chewed khat for some important reasons that clinicians need to consider in their management.
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Chan, Wing-lin, and 陳穎蓮. "Employment in patients presenting with psychotic disorders." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206548.
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Background: Researchers have addressed the extraordinarily high rate of unemployment in patients with psychotic disorders for many years, but few have focused on these patients’ subjective experience of employment in the recovery process.
Method: A thematic analysis was performed by conducting six semistructured interviews with young patients diagnosed with psychotic disorders.
Results: The interviewees agreed on the importance and benefits of employment in their recovery. Acceptance, financial support, and a meaningful life can be secured throughout the working process. However, the interviewees mentioned certain barriers to seeking and sustaining employment. Stigma and low motivation were common problems in searching for a job. Cognitive deficit, the side effects of medication, and interpersonal challenges in the workplace increased the difficulty of sustaining a job.
Most of the interviewees participated in vocational rehabilitation programmes, and they expressed the belief that these programmes can help them enter the labour market at a certain level, but the programme design can be improved further to meet individual needs.
Conclusion: Consistent with previous findings, the patients faced various difficulties in open employment. Employability training, psychoeducation at the corporate level, and self-efficacy development can be considered interventions for improving patients’ vocational outcomes.<br>published_or_final_version<br>Psychological Medicine<br>Master<br>Master of Psychological Medicine
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Tang, Suet-chung Lawson, and 鄧雪松. "Self-referential information processing in psychotic disorders." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206569.
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Motivations
Ideas and delusions of reference (I/DOR) are common psychotic symptoms and can be defined as self-referential experiences in excess of the amount of evidence available in the immediate environment. A putative neurocognitive mechanism is increased automatic attention capture by self-referential (SR) information. This study was carried out to test the hypotheses that 1) compared with patients with no I/DOR, those who have the symptom have increased attentional shift to SR information and 2) there is a positive correlation between the severity of I/DOR and the extent of attentional shift to SR information. Clinical and cognitive correlates of I/DOR were also explored.
Methods
Patients with I/DOR (n=20, mean age 25.2±7.9 years, 4 men) and without I/DOR (n=17, mean age 28.6±8.2 years, 10 men) matched for age and education were assessed for positive symptoms, negative symptoms, mood symptoms and basic neurocognition. I/DOR were phenomenologically assessed using the Ideas of Reference Interview Scale (IRIS). In an interference task, patients were instructed to respond to computerized Stroop tasks while ignoring a voice clip presented binaurally with the subject’s own name (SON) embedded in certain trials. Within-subject differences in reaction time and accuracy between Stroop trials with and without SON were used as parameters to measure the degree of attentional shift to SR information.
Between-group and within-subject differences in the reaction time and accuracy in the interference task were analysed using 2×2 mixed-ANOVA. Bivariate correlation was used to explore the relationship between IRIS scores and performance in the interference task. Stepwise linear regression analysis was used to explore the correlates of I/DOR.
Results
There was statistically significant interaction between conditions with and without SON and patient groups on the reaction time of the interference task (p=0.048). Simple main effects showed the mean difference of reaction time between conditions with and without SON was statistically significant in patients with I/DOR (p=0.001) but not in patients without I/DOR (p=0.862). Parameters used in the interference task correlated highly with IRIS global score and subscores on pervasiveness, self-referential discrepancy, conviction and frequency (r=0.328-0.517, range; p<0.05), unaltered by other clinical and cognitive variables except depressive symptoms and social anxiety. Regression analysis showed that I/DOR were related to depressive symptoms, social anxiety and attentional shift to SON.
Discussion
The significant interaction and simple main effect suggest that I/DOR are associated with a heightened attentional shift to SR information. The robust correlations between IRIS scores and attentional shift to SON provide some evidence to support the continuum hypothesis of I/DOR. The possible roles of emotions in the pathogenesis of I/DOR are discussed.
Significance
With the use of well-matched patient samples and an ecologically valid paradigm based on known human cognitive functions, the present study provided first empirical evidence for a theoretical link between cognitive anomaly and a key psychotic symptom. The SON paradigm provides a promising tool for further research and can potentially be developed into a neurocognitive parameter of I/DOR. The present study also shed light on the complexity of I/DOR in relation to other symptoms to inform future studies.<br>published_or_final_version<br>Psychiatry<br>Master<br>Master of Research in Medicine
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Walker, Dawn-Marie. "Cognitive function in early-onset psychotic disorders." Thesis, University of Nottingham, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.415625.
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Lynham, Amy. "Measuring cognition across mood and psychotic disorders." Thesis, Cardiff University, 2018. http://orca.cf.ac.uk/116386/.
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Cognitive impairments are present in both schizophrenia and bipolar disorder and are strong predictors of functional outcomes for patients. One barrier in cognitive research of these disorders is the lack of large, well-characterised cross-disorder samples with cognitive data. The aims of this thesis were to examine cognition across the bipolar / schizophrenia diagnostic spectrum and to develop a new online cognitive battery for use in psychiatric research. Cognition was examined in participants with bipolar disorder, schizoaffective disorder and schizophrenia through a meta-analysis of existing studies and analysing data from a large well-characterised sample. The main finding was that there is a gradient of increasing cognitive impairment from bipolar disorder through schizoaffective disorder – bipolar type to schizoaffective disorder – depressive type and schizophrenia. Participants with the subtypes of schizoaffective disorder differed in their cognitive performance. Lifetime history of psychosis was associated with cognitive performance across disorders. An online cognitive battery was developed to assess the domains outlined by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative. The battery was validated against the MATRICS Consensus Cognitive Battery and showed that the tasks provided valid measurements of the majority of the MATRICS domains. A large sample of participants with a range of psychiatric disorders was recruited online. An examination of cognition in participants with major depressive disorder, bipolar disorder and schizophrenia showed that cognitive profiles were similar across disorders but participants with schizophrenia have more severe impairments than participants with bipolar disorder. An important concluding observation was that poorer cognitive performance was associated with poorer functional outcome across disorders. The findings of this thesis add to a growing literature showing the importance of examining cognitive function across psychiatric disorders. To date, it is the first study to develop and utilise an online cognitive assessment for psychiatric research.
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Turner, Michelle Hayley. "Post-psychotic trauma : contributory factors and interventions." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/3097/.
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Volume I: Research Component The literature review examines the high prevalence rate of posttraumatic stress disorder (PTSD) in people with a severe mental illness such as psychosis and discusses why such high rates may be found. There is anecdotal and empirical evidence that attests to the distressing nature of psychotic symptoms and treatment related experiences, including hospitalisation. The review looked at the contribution of such experiences in causing symptoms of PTSD. Interventions aimed at reducing symptoms of PTSD in people with a severe mental illness were then evaluated. It was concluded that the studies showed promising results in reducing PTSD symptoms, but the evidence base was still relatively small. Future research is needed to establish what interventions are effective and how established treatments for PTSD in other non-psychotic populations can be adapted to meet the needs of this vulnerable group. The empirical paper presents a quantitative study that aimed to look at the relationship between post-psychotic trauma, shame and depression in a clinical sample of people with first episode psychosis. Symptoms of PTSD were assessed in relation to a traumatic event that had occurred during a previous psychotic episode. The study distinguished between different types of shame to look at their relationship with PTSD symptoms and depression, an area that had not been investigated before in this clinical sample. Participants were asked about their experiences of internal and external shame in relation to having a mental illness and general shame. Consistent with previous research a significant proportion of people had clinically significant levels of psychosis related PTSD symptoms and depression; with shame found to correlate with both. However internal shame was found to make a unique contribution to depression, whilst external and general shame made a unique contribution to PTSD symptoms. This has implications for future research by showing it is not enough to simply measure overall or global shame. It also highlights the need to develop interventions that address shame, depression and symptoms of trauma in people with first episode psychosis. The paper is prepared for the submission to the journal Clinical Psychology and Psychotherapy. Volume II: Clinical Component The second volume of the thesis presents five clinical practice reports. Firstly, a case formulation from a cognitive behavioural and a systemic perspective are presented for an eleven year-old boy with anxiety related difficulties referred to a child and adolescent mental health service (CAMHS). Secondly, an audit was carried out to assess how well a CAMHS service met the guidelines set out by the National Institute for Clinical Excellence (NICE) when intervening with young people and adolescents diagnosed with an eating disorder. Thirdly, a case study is presented from predominantly a narrative perspective for a young woman with a learning disability who had relationship and anxiety related difficulties. In the forth report a single case experimental design was used to evaluate the effectiveness of a cognitive behavioural intervention for paranoid delusions with a man diagnosed with a psychotic disorder, who was under the care of an Early Intervention Service. Lastly an abstract is presented for a case study where cognitive analytic therapy (CAT) was used with a woman who presented with depression within a primary care setting.
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Zanelli, Jolanta. "Trajectory of neurocognitive functioning in psychotic disorders." Thesis, King's College London (University of London), 2012. https://kclpure.kcl.ac.uk/portal/en/theses/trajectory-of-neurocognitive-functioning-in-psychotic-disorders(bf6f70db-6a78-427d-ad5a-3d5ca781741a).html.
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Although cognitive deficits are recognised as a core feature of schizophrenia, their trajectory over the course of the illness is still debated. The primary objectives of this thesis were: (i) to determine the neuropsychological profile at the first episode of psychosis (Chapter 3); (ii) to examine gender differences in the profile of neuropsychological performance (Chapter 4) and (iii) to determine if cognitive abilities decline, remain static or modestly improve throughout the course of psychotic illness (Chapter 5). The first (baseline) analyses form part the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study, a population based, case-control study of first-episode psychosis recruited over a three-year period between September 1997 to August 2000 in London, Bristol and Nottingham. The second analyses (follow-up, where I followed 108 patients and 103 healthy controls) also form part the AESOP study, conducted 6 to 10 years afterwards but only in London and Nottingham. In this thesis I found that early in the course of psychotic illness cognitive deficits are present in all psychotic disorders, but are most severe and pervasive in schizophrenia and least pervasive in bipolar. There was strong evidence for gender differences in neuropsychological performance but these differences were disorder specific. Gender related factors appear to moderate the severity of cognitive deficits in bipolar/mania and depressive psychosis patients. Future schizophrenia patients had an early static developmental impairment on measures relying on knowledge acquisition (verbal IQ). This static deficit increases in size starting in late adolescence or early adult life. There was also an increase in deficit on memory functions. Future bipolar patients had normal or slightly above normal knowledge acquisition scores (verbal IQ) which started to deteriorate starting in early adult life. Thus, both schizophrenia and bipolar/mania patients show dynamic changes in general and specific cognitive functions which start early in childhood and continue across the life span. Both depressive psychosis and other psychotic disorders show different age related changes than schizophrenia or bipolar/mania. However because of small sample size and lack of studies examining the premorbid period therefore it is difficult to provide a life course model.
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Papanastasiou, Evangelos. "The neural basis of psychotic-like experiences." Thesis, King's College London (University of London), 2018. https://kclpure.kcl.ac.uk/portal/en/theses/the-neural-basis-of-psychoticlike-experiences(d153994f-d3fd-488d-92a2-d2222711d49f).html.
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Psychotic‐Like Experiences (PLE) are subclinical manifestation of psychotic symptoms and may reflect an increased vulnerability to psychotic disorders. Contemporary models of psychosis propose that dysfunctional reward processing and emotional dysregulation is involved in the aetiology of psychosis. Objective: To examine the neuroimaging profile of healthy adolescents with an increased presence of PLE, during a face processing and a reward processing task. Method: 1,434 adolescents were assessed at two timepoints using functional MRI during a Faces Task (FT) and a Monetary Incentive Delay (MID) Task at age 14 and 19 years. The sample was stratified into two groups of high PLE and low PLE based on their scores on the CAPE‐42 questionnaire at age 19. The first level analysis focused on a pre‐defined contrast of [Angry Faces] – [Control Stimuli] for the FT and two pre‐defined contrasts of [Anticipation of Large Win] – [Anticipation of No Win] and [Feedback of Large Win] – [Feedback of No Win] for the MID task. The second level analysis examined between‐group differences using an a priori defined region of interest approach (ROIs). I performed a factorial analysis to examine the main effects of group, time and their interaction on brain activation. Additionally, I performed an exploratory analysis, by employing both a cross‐sectional design to compare brain activation levels between the high PLE and low PLE groups at ages 14 and 19, and a longitudinal design to compare brain activation levels between the two timepoints. Results: FT: Adolescents presenting with elevated overall PLE scores at age 19 years exhibited an early state (BL) of hyperactivation in right insular cortical areas, during perception of angry faces; this was replaced by a later state (FU) of hypoactivation in right prefrontal and right limbic cortical areas and left striatal subcortical areas, during perception of angry faces. There was a decrease in activation of right limbic cortical areas, from BL to FU, in the high general PLE group. MID: Adolescents presenting with elevated overall PLE scores at age 19 years exhibited an early state (BL) of hypoactivation in left and right prefrontal and left limbic cortical areas, during reward feedback; this was replaced by a later state (FU) of hypoactivation in right striatal subcortical areas, during the reward anticipation. There was also an increase in activation of left and right prefrontal areas, from BL to FU, in the high general PLE group. Conclusions: The FT results suggest evidence of aberrant changes during adolescent development with reduced limbic and insular activation over time; this might reflect an under‐recruitment of critical areas during perception of emotional faces. The MID task results suggest evidence of compensatory changes during adolescent development with increased prefrontal activation over time; this might allow cognitive control mechanisms to contextualise the PLE, so to prevent transition to clinically significant symptoms; an observation which is consistent with the aberrant salience model of psychosis. My findings reinforce the role of prefrontal, limbic and striatal brain areas in the aetiology of psychosis, beyond the bounds of the illness phenotype and without the confounds of the impact of the illness or the use of antipsychotic medication.
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Ballard, C. G. "Depression and psychotic symptoms in dementia sufferers." Thesis, University of Leicester, 1995. http://hdl.handle.net/2381/34340.
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One hundred and twenty five patients with mild or moderate dementia according to the CAMDEX criteria, who were in contact with either a memory clinic or psychiatric services were assessed. Dementia was diagnosed according to the NINCDS ADRDA criteria, the Hachinski scale, DSMIIIR criteria, HAS AGECAT and the McKeith criteria for Senile Dementia of Lewy Body Type. Depression was diagnosed according to the DSMIIIR and RDC criteria and psychotic symptoms were assessed using the Bums Symptom Checklist. Cognitive impairment was evaluated using the CAMCOG schedule. Informants were interviewed at monthly intervals for one year concerning the symptoms of depression and psychotic symptoms experienced by the dementia sufferers. A repeat CAMCOG was undertaken one year after the initial assessment. The one month prevalence rates of delusions, visual hallucinations and delusional misidentification were 48.4%, 35.5% and 29.0% respectively. Each had a distinct pattern of associations, an impression supported by a principal components analysis which generated four psychotic factors, the three categories already discussed and comfort phenomena. Only sixteen patients had any insight into their psychotic symptoms and 61% were distressed by them. The annual incidence rate of psychotic symptoms was 46.7% and 53% of patients experienced symptom resolution. The number of months during which psychotic symptoms were experienced was significantly associated with the magnitude of cognitive deterioration. The one month prevalence rate of RDC major depression was 27.4%. An additional 27.4% of patients fulfilled the criteria for RDC minor depression. Having Alzheimer's disease was significantly inversely associated with both RDC major depression and DSMIIIR major depression. There were six patients with RDC depression in the context of vascular dementia, all of whom experienced depression for at least three months compared to only 33.3% of the patients with Alzheimer's disease. The annual incidence rate of RDC major depression was 10.6%.
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Armando, Marco. "Psychotic like experiences and 22q11 microdeletion syndrome : two possible models for the investigation of gene-enviroment interaction in psychotic onset." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/3940/.
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Psychotic disorders can be defined as disorders of adaptation to social context. Although heritability is often emphasized, onset must be considered as the end-point of a pathway which involves: 1) genetic heritability; 2) environmental factors; 3) psychopathological factors. Therefore, the current challenge consists in combining different scientific fields aiming at a deeper comprehension of psychotic disorders. Taking off these considerations, this thesis will present research conducted in Rome (Children Hospital Bambino Gesù) and in Birmingham (Department of Psychology, University of Birmingham) by the Author during his PhD. These research are focused on two possible models which can help to better understand the role played by gene/enviroment interaction in the pathogenesis of psychotic disorders. The first model concerns the so-called psychotic-like experiences and is therefore situated in the sphere of the psychopathological factors involved in the pathway to psychosis. The second model concerns 22q11 microdeletion syndrome, a genetic syndrome with high prevalence of psychotic disorders. The thesis starts with a comprehensive review of these topics. Subsequently, the main findings of the research conducted during the PhD will be described and analyzed. Implications are explored, in terms of clinical practice, aetiological pathways, potential treatments and intervention strategies.
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Day, Michael. "Possible selves in early psychosis : the role of the self-concept in adjustment to severe mental illness." Thesis, University of East Anglia, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.302202.
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Gilvarry, Catherine Mary. "Neuropsychological performance of schizophrenic and affective psychotic patients and their first degree relatives : contributions to vulnerability to psychosis." Thesis, King's College London (University of London), 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.418067.
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Lewis, Heledd Wyn. "A formal comparison of spiritual and psychotic experiences." Thesis, Bangor University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297998.
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Tully, Sarah. "The cognitive and behavioural consequences of psychotic experiences." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/the-cognitive-and-behavioural-consequences-of-psychotic-experiences(67902cbc-f19f-4ea6-a932-49b0f59675f8).html.
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This thesis explored the ways in which people experiencing psychosis respond to their distressing experiences. Mixed methodology was used to address the research questions. Chapter two included a thorough systematic review and meta-analysis to investigate the relationship between safety seeking behaviours and psychosis. This review concluded that safety seeking behaviours, avoidance and resistance were associated with increased distress whereas engagement was associated with reduced distress. The review also highlighted some conceptual difficulties with differentiating between safety seeking and coping in this population. Study one, a qualitative exploration of how people respond to the experience of psychosis is presented in chapter four. This study found three key themes relating to perceived importance of responses, accuracy of threat appraisals and perceptions of ability to control experiences. An overarching theme of fighting a daily battle to maintain functioning was also identified. This analysis provided some support for the model of safety seeking responses but also demonstrated additional complexities in the way that people respond to their distressing experiences. Chapter five presents study two, the development and validation of a measure of responses to psychosis. Principal Components Analysis identified three subscales: threat monitoring and avoidance, social control and reassurance seeking and conscious self-regulation attempts. The subscales were found to have good internal consistency and convergent validity. To build on this work, study three used Structural Equation Modelling to test an integrative cognitive and metacognitive model of voice hearing (chapter six). In support of this model, it was found that voice hearing predicted beliefs and beliefs predicted responses and negative affect. Responses were not predicted either by voice hearing or negative affect. It was also found that both schematic beliefs and meta-worry mediated the relationship between avoidance and negative affect. Finally, in study four, presented in chapter seven, the response styles of attentional avoidance and attentional focusing were manipulated in response to an ambiguous auditory task in an experimental study. It was found that the attentional avoidance response resulted in a significantly greater increase in words heard during the task. However, the manipulation did not have an impact on distress levels. This thesis has demonstrated significant relationships between response styles, distress, appraisals and voice hearing. This, therefore, confirms the important role of responses to unusual experiences in models of psychosis. It appears that avoidance is likely to be unhelpful however, it should not be assumed that other responses are either helpful or unhelpful as this is likely to be person and context specific. The clinical and research implications of this are discussed.
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Gardin, Tova. "Hippocampal Subfield Alterations Across the Psychotic Disease Spectrum." Thesis, Harvard University, 2017. http://nrs.harvard.edu/urn-3:HUL.InstRepos:32676134.
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Psychiatry stands at a pivotal point of development. With the advent of brain imaging modalities, descriptive diagnostic criteria have been called into question. Psychotic disorders, historically dichotomized into “schizophrenia” and “bipolar disorder,” and the intermediate “schizoaffective disorder,” have been shown to overlap in clinical symptomatology, familial inheritance, and genetic association studies. Scientific investigation of disease pathogenesis provides an opportunity to develop biological diagnostic criteria from the ground upwards – correlating anatomy, pathophysiology, genetics, and symptomatology. In this context, structural MRI studies have the capacity to shed light on structural abnormalities underlying psychotic disorders (schizophrenia, schizoaffective disorder, and psychotic bipolar disorder) and contribute to the development of a comprehensive mechanistic model of disease. Neuropathological and in vivo neuroimaging studies have identified the temporal lobe as a key area of alteration in schizophrenia, but large-scale studies examining the hippocampal volumes of patients across the psychotic spectrum have not yet been performed. Further, until recently, the manual labor and error involved in parcellating hippocampal subfield volumes made the task unfeasible. New automatic parcellation techniques enable the analysis of hippocampal subfield volumes among patients with schizophrenia, schizoaffective disorder, and bipolar disorder.
The objectives of our study were to: (1) investigate using magnetic resonance imaging hippocampal volume in addition to entorhinal cortex volume, parahippocampal gyrus volume, and hippocampal subfield volumes in patients with schizophrenia, schizoaffective disorder, and bipolar disorder; and, to (2) correlate volumetric alterations with clinical metrics of psychosis and cognition. We utilized a case-control cross- sectional design to collect data from patients with schizophrenia (n=219), patients with schizoaffective disorder (n=142), patients with psychotic bipolar disorder (n=188), and healthy controls (n=337). Freesurfer image analysis software was utilized to automatically parcellate and quantify hippocampal, hippocampal subfield, entorhinal cortex, and parahippocampal gyrus volumes. Clinical ratings and neuropsychological tests were administered as well to assess positive symptoms and cognition. Bilateral hippocampal volume alterations were noted among patients with all three psychotic disorders, while alterations in the surrounding medial temporal lobe regions were noted only in schizoaffective disorder and schizophrenia, but not in patients with bipolar disorder. While widespread hippocampal subfield volume alterations were noted in schizophrenia and schizoaffective disorder, only the cornu ammonis 2/3, dentate gyrus, and subicular regions were noted to be altered across all three psychotic disorders. The most prominent alterations were noted in the cornu ammonis 2/3. Hippocampal volumes were negatively correlated with psychosis and positively correlated with measures of declarative memory. Findings suggest that alterations in the hippocampus are present across psychotic disorders and may contribute to the pathogenesis of psychosis. In particular, alterations in the cornu ammonis, an area which supports memory pattern completion, and in the dentate gyrus, an area which supports memory separation may play a role in the pathophysiology of psychosis.
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Slack, Tom Gavin Hume. "Insight in psychosis : a systematic review : the constructs of insight in psychosis and their measurement, &, An exploration of current practices in the assessment and intervention of insight in psychosis within Scotland's Forensic Mental Health Services : clinical psychologists' perspective." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/26006.
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Poor insight has clinical significance as a predictor of non-adherence to treatment, increased number of relapses, hospitalisations, recovery and risk of violence. Empirical research has led to advances in the redefinition, knowledge and understanding of insight in psychosis. However, the use of a wide range of definitions and measures has created difficulties in interpreting research findings, without clarifying the concepts being measured and evaluating the quality of their associated assessment tool. Therefore, the aim of the first piece of work, a Systematic Review (SR), was to identify and describe the constructs of insight in psychosis and their assessment tools and briefly evaluate their psychometric properties. Insight in psychosis is particularly relevant to Forensic Mental Health Services, given its link with offending behaviour and risk to others. However, outside of those provided by risk appraisal tools, there are no current guidelines that specifically target the assessment, or intervention, of insight. Therefore, the second piece of work, a research project (RP), aimed to explore current practices, as described by experienced clinicians. The SR identified twelve assessment tools and fourteen papers for detailed analysis. Twelve theoretical constructs were identified, the most prominent being awareness of mental illness and awareness of the need for treatment. Other prominent theoretical constructs included awareness of negative consequences of illness and awareness of generic or specific symptoms. However, few of the subscales associated with each theoretical construct were supported by empirical evidence. Further work to clarify aspects of insight that are important areas for intervention, along with the provision of data to support these, should continue to be a focus for on-going research. The RP was a qualitative design using Thematic Analysis. Data was collected by semi-structured interviews from 11 qualified Clinical Psychologists working in Forensic Mental Health Services across Scotland. The RP identified three overarching themes. The first “risk related” illustrated the influence of risk to other when assessing and treating patients. The second “holistic approach” illustrated that insight or mental illness was rarely looked at in isolation. The third theme “no specific or satisfactory unified approach” illustrated the diversity of the conceptualising, assessment and treatment of insight. Opportunities exist to develop a more uniformed approach and to introduce or develop outcome measures for interventions.
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Kleman, Drew T. "Psychotic/semantic of signs, stigmata, and the historical asylum /." Cincinnati, Ohio : University of Cincinnati, 2006. http://www.ohiolink.edu/etd/view.cgi?acc%5Fnum=ucin1147909874.
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Thesis (Master of Architecture)--University of Cincinnati, 2006.<br>Title from electronic thesis title page (viewed July 24, 2006). Includes abstract. Keywords: semiotics; semiotic analysis of architecture; historical asylum; Michel Foucault; construction of meaning; surface meaning; spatial meaning; mental health community center. Includes bibliographical references.
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Yuen, Chi-hong, and 袁志康. "Emotion regulation patterns of psychotic patients and their affect." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/198809.
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Background: In recent years, the study of emotion in psychosis has been neglected, and it would seem from the literature that emotion is not related to the formation or prediction of psychosis. Because emotions are the subjective experience of patients, they are not easily quantified. However, the latest fMRI research has shown that emotion and brain function are related and that understanding emotion is valuable for understanding patients’ cognitive function and its potential relationship with psychosis. Emotion regulation can be divided into two different categories based on when in the sequence of emotion regulation they appear. Cognitive reappraisal is antecedent-focused, and suppression is response-focused. I hypothesize that cognitive reappraisal can decrease maladaptive thought and emotions. In contrast, expressive suppression can reduce the appearance of emotion but not inner emotion. Furthermore, inhibiting a preference may not stop maladaptive emotions from arising over a long period of time.
Methods: Two groups were recruited in study: a clinical group of patients with psychosis and a nonclinical group of healthy adolescents with no record of mental illness.
Twenty-four psychotic patients were recruited from Early Assessment Services for Young People (EASY) in Queen Mary Hospital, and 30 nonclinical participants were recruited from nongovernmental organizations and schools. The participants ranged from 17 to 34 years old and were native Cantonese speakers living in Hong Kong. They completed a variety of measures of emotion regulation, depression, and anxiety.
Results: The clinical and nonclinical groups were similar on several dimensions, including their demographic information and pattern of strategy usage. A higher percentage used both emotion-regulation strategies to cope with maladaptive emotion, and fewer used a single strategy. However, the two groups had significantly different outcomes from using expressive suppression as their major emotion regulation pattern. The clinical group was more likely to have higher depressive symptoms (moderate to severe levels on the Beck Depression Inventory).
Conclusion: It is valuable to assess emotion-regulation strategies in order to evaluate patients’ habitual coping strategy. Cognitive reappraisal seems to allow participants to retain their cognitive function when maladaptive emotions are not fully occupying their cognitive resources. In contrast, when maladaptive emotion reaches a very high level, it cannot be contained through cognitive reappraisal. Habitual use of expressive suppression affects cognitive functioning and depletes resources that could be used for other regulation attempts. Unsuccessfully regulated maladaptive emotions could be a risk factor that occupies the cognitive functioning of psychotic patients. In order to solidify this hypothesis, further longitudinal research on psychotic patients’ emotional history is needed. More research is needed to understand the relationship between maladaptive emotions, cognitive function, and psychosis.<br>published_or_final_version<br>Psychological Medicine<br>Master<br>Master of Psychological Medicine
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Cardno, Alastair George. "The quantitative genetics of clinical variation in psychotic illnesses." Thesis, Cardiff University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.394591.
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Smailes, David. "Parental bonding, attachment, reality discrimination, and psychotic-like experiences." Thesis, Durham University, 2014. http://etheses.dur.ac.uk/10705/.
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Psychological models of psychotic experiences suggest that social adversity (e.g., difficult family relationships, bullying) and anomalous percepts play an important role in the development of paranoid thinking, while intrusive cognitions and problems in reality discrimination play an important role in the development of auditory hallucinations (AH). The studies reported in this thesis examined a number of research questions relevant to these models, by investigating psychotic experiences in non-clinical populations (typically referred to as psychotic-like experiences, or PLEs). In Study 1 it was shown that the association between poor parental bonding and PLEs is mediated by individual differences in exposure to bullying and levels of negative affect. In Study 2 it was shown that associations between insecure attachment styles and paranoid thinking are mediated by individual differences in loneliness. In Study 3 it was shown that the association between experiencing anomalous percepts and paranoid thinking is moderated by individual differences in attachment anxiety. In Study 4 it was shown that the association between experiencing intrusive thoughts and AH-proneness is moderated by individual differences in reality discrimination skills. Finally, in Study 5 it was shown that a person’s reality discrimination abilities can be weakened through the induction of a negative mood. The studies included in this thesis, therefore, show how a variety of social, emotional, and cognitive factors interact with each other to foster or preclude the development of PLEs in ways that extend current psychological models of AH and paranoid thinking.
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Reid, Kirsten. "Prevalence and correlates of anxiety disorders in psychotic illness." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27379.
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Background: Comorbid anxiety disorders in psychotic illness are reported in the international literature as highly prevalent and have a significant negative impact on patient outcomes. Local literature describing such comorbidity in the South African population is limited and clinically, anxiety symptoms are seldom recognised or treated in patients with psychotic disorders. More data on prevalence rates across psychotic disorder diagnoses, as well as sociodemographic correlates would aid recognition, diagnosis, and treatment, and potentially improve clinical outcomes in this population. Method: We performed a secondary analysis of an existing database which comprised data from participants of three previous studies. The sample was made up of patients from Valkenberg Hospital and healthcare facilities in its catchment area. All patients had a diagnosis of a psychotic disorder. Socio-demographic information was collected using a structured questionnaire. Clinical information and diagnosis was determined using the Structured Clinical Interview for DSM (SCID-I). Rates of comorbid anxiety disorders were compared across various sociodemographic categories. Results: The overall prevalence of any anxiety disorder in the entire sample (N=226) was 14.6% (n=33), 95% CI [10.27-19.89%]. The most common anxiety disorder comorbidities were, in descending order, panic disorder (n=12, 5.31%; 95% CI [2.77-9.09%]), PTSD (n=9, 3.98%; 95% CI [1.84-7.42%]), specific phobia (n=7, 3.10%; 95% CI [1.25-6.28%]), anxiety disorder not otherwise specified (n=7, 3.10%; 95% CI [1.25-6.28%]), social phobia (n=4, 1.77%; 95% CI [0.48%-4.47%]), generalised anxiety disorder (n=4, 1.77%; 95% CI [0.48-4.47%]), substance-induced anxiety disorder (n=4, 1.77%; 95% CI [0.48-4.47%]) and obsessive compulsive disorder (n=2, 0.88%; 95% CI [0.11-3.16%]). There was a significant association between diagnosis and the presence of post-traumatic stress disorder (PTSD), with the schizoaffective disorder group having a higher rate of PTSD (13.3% vs. 3.3% in schizophrenia, 3.2% in substance-induced mood/psychotic disorder and 0% in bipolar I disorder) (Fisher's exact test, p=0.039). In turn, there was a trend level association between diagnosis and the presence of panic disorder (PD), with schizoaffective disorder patients having higher rates of PD (16.6% vs. 4.1% in schizophrenia spectrum, 3.2% in substance-induced mood/psychotic disorder and 2.2% in bipolar I disorder) (Fisher's exact test, p=0.052). A significant association was found between level of education and the presence of PTSD, with higher rates of PTSD in patients with seven or less years of education (8.8%) compared to lower rates in those with 8-12 years of education (5.3%) and > 12years of education (0%) (Fisher's exact test, p=0.020). Conclusion: The overall prevalence of anxiety disorders in psychotic illness was lower than what has been described in previous literature. Prevalence rates of individual anxiety disorders were also lower than previously published literature. Possible reasons for this include use of the SCID which utilises a strict diagnostic hierarchy, that the majority of the sample were in-patients, no use of self-report questionnaires or other anxiety-specific diagnostic instruments, or possible geographical and/or ethnic differences in South African patients. The most frequent comorbid anxiety disorders in our study were panic disorder and PTSD. This is out of keeping with other literature which has mostly found obsessive compulsive disorder and social anxiety disorder to be the most common anxiety comorbidities in psychotic illness. Further research into comorbid anxiety in psychotic disorders is needed, particularly amongst South African populations.
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Eisenbrandt, Lydia L., and Jill D. Stinson. "Differentiating Forensic Inpatients With and Without Psychotic Spectrum Diagnoses." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/7938.
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KLEMAN, DREW T. "PSYCHOTIC/SEMANTIC: OF SIGNS, STIGMATA, AND THE HISTORICAL ASYLUM." University of Cincinnati / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1147909874.
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Eriksson, Linda Kristina. "Do psychosocial interventions for psychotic disorders improve quality of life in adults with psychotic disorders in forensic settings? : a systematic review and narrative synthesis ; and, Modified metacognitive training for negative symptoms in psychosis : a feasibility study." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/31197.
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This thesis focuses on psychosocial interventions for psychosis. It consists of two parts: a systematic review on quality of life in forensic settings and an empirical study on negative symptoms. The systematic review follows the publication guidelines of the journal International Journal of Forensic Mental Health whilst the empirical study follows the publication guidelines of the journal Clinical Psychology and Psychotherapy. Reasonable adjustments have been made to the formatting of this thesis to enhance readability. Purpose: The systematic literature review aimed to summarise and critically appraise studies that have evaluated the effects of psychosocial interventions for psychotic disorders in forensic settings on quality of life. The empirical study aimed to evaluate the feasibility of Metacognitive Training (MCT) for negative symptoms and to identify mechanisms of change. Methods: The literature was systematically searched (using four databases) for research that included any quantitative measure of quality of life (i.e. self-esteem, quality of life, life satisfaction, and/or self-efficacy in relation to life-goals). In the empirical study, a new intervention was developed by modifying MCT for negative symptoms and four aspects of feasibility were evaluated: acceptability, practicality, demand and limited efficacy. The quantitative approach was supplemented with qualitative interviews on participants' views of the intervention. In addition, potential mechanisms of change were evaluated using a promising new method for analysing data from case-series: multilevel modeling. Results: In total, 10 papers met the inclusion criteria in the systematic review. Significant improvements in quality of life were found in five studies. The modified version of MCT showed good feasibility as demonstrated by the attendance rate, the positive oral feedback from participants and the multidisciplinary team, and the improvements on negative symptoms that were found following the intervention. Multilevel modeling proved useful in explaining the variance attributable to three different predictors: depression, internalised stigma, and reflective functioning. Conclusions: It was found that quality of life can be improved in forensic settings using psychosocial interventions. The pilot study indicated that MCT for negative symptoms has high feasibility and that changes in negative symptoms can partially be explained by depression, stigma, and reflective functioning.
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Costa, Felipe Bauer Pinto da. "Estudo prospectivo das diferenças clínicas e funcionais entre pacientes internados por depressão psicótica e não-psicótica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/119420.
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Introdução: A Depressão Psicótica (DP) afeta cerca de 15-20% dos pacientes com diagnóstico de depressão. Esta condição está ligada a maior cronicidade, maior incidência de tentativas de suicídio e maior frequência de internação hospitalar em relação à Depressão Não-Psicótica. No entanto, evidências recentes sugerem que a incidência de características psicóticas pode não estar relacionada à intensidade dos sintomas depressivos. O curso distinto de doença, associado a pior resposta ao tratamento e a pior prognóstico suscitam a discussão de que a depressão psicótica pode ser uma entidade clínica distinta da depressão, representando um ponto em um continuum que tem em um de seus extremos os transtornos psicóticos e no outro, os transtornos de humor. Objetivos: Avaliar se a presença de sintomas psicóticos em pacientes internados por episódio depressivo se correlaciona com a intensidade de sintomas depressivos. Avaliar se há diferenças clínicas e funcionais que podem se relacionar com os sintomas psicóticos dos pacientes da amostra. Observar a melhora de sintomatologia psiquiátrica ao longo da internação, e se há diferença na variação de sintomas, ao longo da internação, entre os pacientes psicóticos e não-psicóticos. Métodos: 288 pacientes internados por episódio depressivo em uma unidade psiquiátrica de um hospital geral universitário foram avaliados na admissão e na alta hospitalar. Foi realizada entrevista semi-estruturada com o MINI para avaliação diagnóstica. Nos dois momentos de avaliação foram aplicadas a Escala de Hamilton para Avaliação de Depressão (HAM-D), a Escala Breve de Avaliação Psiquiátrica (BPRS), a avaliação da Impressão Clínica Global (CGI) e a Escala Global de Avaliação do Funcionamento (GAF). Outros parâmetros clínicos e epidemiológicos também foram avaliados: idade de início de sintomas, quantidade de internações prévias, tentativas de suicídio prévias, tempo de duração da internação atual e realização de Eletroconvulsoterapia (ECT) durante a internação. Resultados: 131 pacientes (45,4%) apresentaram sintomas psicóticos. Após ajuste para controle de variáveis que tinham potencial de viés de confusão – história prévia de mania ou hipomania, história prévia de uso de substâncias, sexo, idade, e anos de estudo – os dois grupos tiveram resultados similares nos resultados da HAM-D, tanto na admissão quanto na alta. Em relação às outras medidas, no entanto, os pacientes com depressão psicótica apresentaram piores níveis de funcionamento (GAF), piores resultados na avaliação clínica (CGI) e escores mais elevados na BPRS, na admissão e na alta hospitalar. Conclusão: Os pacientes com depressão psicótica apresentaram história mais grave de sintomas psiquiátricos e maior prejuízo funcional. No entanto, as diferenças entre os pacientes psicóticos e não-psicóticos não tiveram relação com os sintomas depressivos dos pacientes. Tais achados vão ao encontro de evidências recentes que sugerem que a depressão psicótica pode ser um transtorno distinto da depressão maior.<br>Introduction: Psychotic Depression (DP) is a medical condition that affects a significant portion of depressive patients, 15-20%. This disorder is linked to greater cronicity, higher incidence of suicide attempts and a higher frequency of hospitalization, when compared to depressive episodes without psychotic features. Nevertheless, recent evidences suggest that the presence of psychotic symptoms may not correlate to depressive symptoms severity. The discrete clinical course, along with worse response to usual treatment and worse prognosis draw a hypothesis that Psychotic Depression might be a distinct disorder in relation to major depression. It reflects the intersection of psychotic and affective dimensions, and may be placed in a point of a continuum between psychotic and affective disorders. Objectives: To evaluate if the presence of psychotic symptoms in hospitalized depressive patients correlates to depressive symptoms intensity. To evaluate the existence of clinical and functioning differences among psychotic and non-psychotic depressive inpatients that could be related to the psychotic features. To estimate clinical improvement during hospitalization, and if there are dissimilarities in the variation of symptoms between psychotic and non-psychotic depressive individuals. Methods: 288 depressive inpatients of a psychiatric ward of a university tertiary hospital were assessed at admission and at discharge. We conducted MINI semi-structured interview to determine patient diagnosis. At both assessments we applied the Hamilton Depression Rating Scale (HAM-D), the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF). Other clinical and epidemiological parameters were also assessed: age at onset, number of previous hospitalizations, previous suicide attempts, length of stay and Electroconvulsive therapy (ECT) in current hospitalization. Results: 131 patients (45,4%) had psychotic features. After adjusting for potential confounding variables – previous presence of mania or hypomania, history of substance use, gender, age and years of study –, both psychotic and non-psychotic depressive patients presented similar HAM-D scores at admission and at discharge. However, psychotic depressive inpatients showed worse functioning levels (GAF), worse clinical status (CGI) and higher BPRS scores, both at admission and at discharge. Conclusion: Psychotic depressive inpatients presented more severe history of psychiatric symptoms and greater functioning disability. The differences between both groups of patients did not correlate to depressive symptoms. These findings are in conformity with recent evidences that suggest that psychotic depression might be a distinct disorder in relation to major depression.
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Drury, Valerie. "Cognitive therapy and recovery from acute psychosis : a randomised controlled trial." Thesis, University of Birmingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.247312.
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Weinberg, Laura. "Living a valued life with psychosis : the relationship between psychotic symptoms, illness beliefs, experiential avoidance and success at valued living." Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/29419.
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The aim of this study is to investigate factors associated with success at valued living in a sample of individuals who have experienced psychosis. The association between psychotic symptoms, illness beliefs, experiential avoidance and success at valued living is explored. Method: Eighty-four individuals with experiences of psychosis completed standardised self-report measures of beliefs about illness, experiential avoidance and valued living. The researcher rated an individual’s psychotic symptoms with an interview-based measure. Data were analysed using correlations and path analysis, an extension of multiple regression. Results: Results indicated that success at valued living was best predicted by experiential avoidance. Neither psychotic symptoms nor illness beliefs were found to be directly associated with success at valued living. The clinical and theoretical implications of these findings are discussed.
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Guloksuz, S., Nierop M. van, R. Lieb, Winkel R. van, H. U. Wittchen, and Os J. van. "Evidence that the presence of psychosis in nonpsychotic disorder is environment-dependent and mediated by severity of non-psychotic psychopathology." Cambridge University Press, 2015. https://tud.qucosa.de/id/qucosa%3A39035.
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Background. Evidence suggests that in affective, non-psychotic disorders: (i) environmental exposures increase risk of subthreshold psychotic experiences (PEs) and strengthen connectivity between domains of affective and subthreshold psychotic psychopathology; and (ii) PEs are a marker of illness severity.
Method. In 3021 adolescents from the Early Developmental Stages of Psychopathology cohort, we tested whether the association between PEs and presence of DSM-IV mood disorder (MD)/obsessive–compulsive disorder (OCD) would be moderated by risk factors for psychosis (cannabis use, childhood trauma and urbanicity), using the interaction contrast ratio (ICR) method. Furthermore, we analysed whether the interaction between environment and PEs was mediated by non-psychotic psychopathology.
Results. The association between PEs and MD/OCD was moderated by urbanicity (ICR = 2.46, p = 0.005), cannabis use (ICR = 3.76, p = 0.010) and, suggestively, trauma (ICR = 1.91, p = 0.063). Exposure to more than one environmental risk factor increased the likelihood of co-expression of PEs in a dose–response fashion. Moderating effects of environmental exposures were largely mediated by the severity of general non-psychotic psychopathology (percentage explained 56–68%, all p < 0.001). Within individuals with MD/OCD, the association between PEs and help-seeking behaviour, as an index of severity, was moderated by trauma (ICR = 1.87, p = 0.009) and urbanicity (ICR = 1.48, p = 0.005), but not by cannabis use.
Conclusions. In non-psychotic disorder, environmental factors increase the likelihood of psychosis admixture and helpseeking behaviour through an increase in general psychopathology. The findings are compatible with a relational model of psychopathology in which more severe clinical states are the result of environment-induced disturbances spreading through a psychopathology network.