Schizophrenia is a complex and pervasive brain disorder that effects millions of people in the United States. There are three tiers of symptoms associated with the disorder, they include: positive symptoms, negative symptoms and thought disorders. The most common method of treatment for this disorder involves the use of antipsychotic medications, and while these medications have been shown to be effective in treating certain positive symptoms of the disorder, they have a tendency to be less effective in treating the negative cluster of symptoms and the thought disorders that can be highly debilitating for patients. The aim of this review was to determine the level of effectiveness of psychosocial treatments for the disorder, and in particular to look in to Cognitive- Behavioral Therapy (CBT) as an adjunctive method of treatment to be used in conjunction with medication. By performing searches using the PsycInfo, ERIC, EBSCO and Medline databases, the researcher was able to draw the conclusion that while there are some complications and areas of improvement in study construction, CBT can indeed be a helpful method of treatment for many patients. Importantly, CBT tends to be a very flexible treatment that can accommodate many different combinations of symptoms at varying levels or severity and stages of the illness. A discussion of a possible model of treatment that uses CBT was also undertaken to provide readers with a practical example of how this form of treatment can be used. / text

Background: Parkinson’s disease (PD) is a common, progressive neurodegenerative disorder, recognized by the motor symptoms of bradykinesia, tremor, rigidity, and postural impairment. At clinical onset, extensive amounts of dopaminergic neurons have already been lost. The duration of this prodromal phase is uncertain, and it is thought to include predominantly non-motor symptoms. The progressive nature and the symptoms of PD are disabling and reduces the quality of life. Among patients affected in working age, early cessation of employment is common, and such socioeconomic consequences of PD may contribute to an impaired quality of life. The aims of this thesis were to investigate the life situation for people affected by PD in working age, with attention to factors of importance for quality of life and working situation, and to evaluate long-term associations between potential prodromal signs and the later development of PD.Methods: We used a postal survey to investigate the self-perceived life situation among working-aged individuals with PD compared to matched controls, with a specific attention to socioeconomic consequences of disease (paper I). To investigate risk markers preceding the diagnosis of PD (paper II-IV), we used data from nationwide registers. Study II was performed as a cohort study, based on the Swedish Military Service Conscription Register, and study III-IV were performed as nested case-control studies based on a cohort comprising all Swedish citizens aged ≥50 years in 2005.Results: In the survey study (paper I), 38% of the PD participants and 9% of the controls were dissatisfied with life as a whole, and the working situation was an independent risk factor for dissatisfaction with life. In total, 59% of the PD participants had reduced working hours or stopped working due to PD, and many PD participants struggled to cope with their work demands. Support from employer was associated with a higher likelihood to remain employed.We found that low muscle strength in young adulthood, (paper II) and depression (paper III) were associated with an increased risk of PD over follow-up times of more than 2 decades, and that patients with PD were at increased risk of fall-related injuries, hip fractures in particular, a decade or more before the PD diagnosis (paper IV). For depression and fall-related injuries, the association with PD was clearly time-dependent, strongest in the last years before the diagnosis of PD.Conclusions: The results suggest that the prodromal phase of PD may last for more than 2 decades and include also motor symptoms. The consequences of PD include a reduced quality of life associated with the working situation. Employer’s support appear to be particularly important for a successful vocational rehabilitation.

Prodromes of schizophrenia or prodromes of psychosis are a relatively new and expanding field of interest in psychiatric research. They are seen by some researchers as the initial symptom of having schizophrenia and have become a crucial topic in early psychosis research and intervention. In this thesis current psychiatric research publications were analysed and eleven prospectively psychotic patients were interviewed. The research publications analysed were applyed on the information given by the patients, and the analysis showed that it was easy to find prodromes or prodrome-like phenomena in all the collected interviews. In addition a second analysis was performed on the material, a phenomenological psychological analysis, showing a more subject-oriented dimension of the interviews. This led to a further aim, analysing what explanations could be given of these phenomena. There are probably many possibilities of getting the diagnosis of schizophrenia, but the examples in this study show that long-term abuse, often sexual actually can trigger psychiatric conditions corresponding to the definition of “prodromes of schizophrenia” according to some psychiatric publications as well as “schizophrenia” according to DSM and ICD. This means that trauma and/or neglect proved to be a likely partial causal condition of the prodrome- like phenomena or schizophrenia to occur. However, trauma has not been shown to be a necessary condition for the occurrence of prodrome-like phenomena or schizophrenia. In the discussion of the results some consequences deriving from using different interpretations and explanations of the phenomena are analysed, for example using the prodromes of psychosis for the assessments of a coming psychosis, especially schizophrenia. I emphasize, because of the results of the phenomenological case analyses, the value of several dimensions of understanding prodrome-like phenomena as well as schizophrenia and schizophrenia-like conditions, especially as early as the initial phase. / Prodromalfasen till schizofreni är ett relativt nytt begrepp och det utgör ett expanderande intresseområde för psykiatrisk forskning. Förändringar i prodromalfasen ses av vissa forskare som de första tecknen på schizofreni, och dessa fenomen har kommit i fokus speciellt vad gäller tidig upptäckt och intervention inom schizofreniforskning. I denna avhandling analyseras åtskilliga psykiatriska texter som behandlar prodromalfasens fenomen. I den empiriska studien har elva personer, som senare utvecklat psykotiska symtom, intervjuats.  Två etablerade listor på prodromalfenomen testades på det empiriska materialet. Resultaten av den analysen visade att de gick att finna prodromalliknande fenomen hos alla intervjuade patienter. En andra fenomenologisk och mer subjektorienterad analys av det empiriska materialet genomfördes parallellt. Resultaten av de två analyserna ledde till ett tredje fokus för avhandlingen, nämligen frågan om möjliga kausalförklaringar till de prodromalliknande fenomenen. Det finns förmodligen många orsaker till att en person uppvisar symtom som överensstämmer med diagnosen schizofreni. Exemplen i denna studie visar dock att långvariga, ofta sexuella, övergrepp kan leda till psykiatriska tillstånd som överensstämmer med fenomen i prodromalfasen och med själva diagnosen schizofreni enligt kriterierna i DSM-IV och ICD-10. Avhandlingens huvudhypotes är således att svåra trauman utgör delorsaker både till prodromalliknande fenomen liksom till tillstånd som diagnosticerats som schizofreni. Avhandlingens resultat ger dock ingen anledning att anta att trauman utgör nödvändiga betingelser för schizofreni. I avhandlingens resultatdiskussion lyfter författaren fram några viktiga konsekvenser av olika definitioner av begreppen prodromalfenomen och schizofreni bl a vad avser förslag till terapeutiska interventioner. Mot bakgrund av resultaten från den fenomenologiska analysen understryks vikten av en bred förståelse av prodromalliknande fenomen liksom av fenomen som diagnosticeras som schizofreni.