Introduction: L'intérêt pour les premiers stades de la psychose a augmenté au cours des dernières années, vu que cette maladie apparaît pendant l'adolescence. Ensuite, de nombreuses études ont révélé que l'identification et le traitement précoces peuvent retarder la transition vers un trouble mental, et aussi prévenir des effets néfastes sur le fonctionnement global. Afin d'identifier ces individus, certains critères cliniques ont déjà été développés, on sait ainsi que les enfants avec risque génétique de psychose s'engagent tôt dans une trajectoire cognitive déficiente. Même si les modèles de prédiction sont très prometteurs, le nombre de faux positifs est élevé, ce qui nuit au développement de traitements préventifs. L'objectif du premier article était d'identifier deux profils neurocognitifs parmi les descendants des parents avec psychose. Le deuxième article avait comme objectif d'évaluer l'effet sur la transition d'interventions non pharmacologiques, chez les individus à risque de psychose et leur effet sur les comorbidités non psychotiques. Méthodologie: Une analyse de cluster hiérarchique a été effectuée afin d'identifier deux profils neurocognitifs. Ensuite, une analyse systématique et méta-analyse d'essais contrôlés randomisés a été effectué pour analyser les interventions non pharmacologiques publiées jusqu'à cette date. Résultats: L'analyse de cluster a montré l‟existence de deux sous-groupes de descendants à risque élevé, l'un d'entre eux ayant montré une performance cognitive presque identique aux sujets témoins, tandis que l'autre ayant eu des résultats pires que les scores du groupe control. La méta-analyse a rapporté que les thérapies non pharmacologiques étaient associées à un risque réduit de transition vers la psychose. Conclusion: Les interventions non pharmacologiques peuvent avoir du potentiel de traitement chez les individus à risque de psychose. Toutefois on a besoin de plus d‟études concentrés à réduire les taux de retrait. Notre étude suggère que les interventions visant à renforcer l‟aspect neurocognitif devraient être abordées plus tôt. D'autres recherches de types longitudinales sont nécessaires / Introduction: Interest in the early stages of psychosis has been increasing in the last years, mainly because it appears mostly in adolescence. Also, numerous studies have reported that early identification and treatment may not only delay the transition to a frank mental disorder, but also prevent detrimental effects on global functioning. In order to identify these individuals, some clinical criteria have already been developed; it is known for example that children at genetic risk of psychosis engage early in a deficient cognitive trajectory. Even though models of prediction are very promising, the number of false positives is still high, which impairs the development of preventive treatments. The objective of the first article was to identify two neurocognitive profiles among offspring at genetic risk of psychosis. The objective of the second article was to assess, the effect of non-pharmacological interventions on transition to psychosis, compared to any no non-pharmacological treatment, in individuals at risk of psychosis and the effect of these interventions on non-psychotic comorbidities. Methodology: First a hierarchical clustering analysis was performed in order to identify the two neurocognitive profiles. Then a systematic review and meta-analysis of randomized controlled trials was conducted to analyse all non-pharmacological interventions published until now. Results: The cluster analysis yielded two subgroups of high risk offspring, one of them showing a cognitive performance almost identical to control subjects, whereas the other having performed worse than the control scores. The meta-analysis reported that non-pharmacological therapies were associated with a reduced risk of transition to psychosis. Conclusion: Non-pharmacological interventions may have potential in the treatment of individuals at risk of psychosis however; further research is needed accompanied by efforts to diminish withdrawal rates. Our study suggests that interventions with a neurocognitive target should be addressed earlier. Still further research is needed in longitudinal studies.

No description available.

Discharge planning for hospitalized chronically mentally ill usually involves only verbal descriptions of community residential options. Psychosis often impairs ability to conceptualize abstract information, and quality of the choice process may be poor without describing options in concrete form, i.e., using written descriptions and photographs. A random sample (N= 90) of Dammasch State Hospital (Wilsonville, Oregon) patient population, comprising persons diagnosed schizophrenic, schizoaffective, organic mental disorder, and bipolar, were assigned to three treatment groups, asked to rank six community residential options suited for them when they were ready to leave the hospital. The three treatment groups were presented the same set of residential options, but the manner of presentation of options was manipulated: first group received verbal descriptions, second group received verbal descriptions with placards containing printed highlights of descriptions, third group received verbal descriptions, printed descriptions, and five photographs of each type of residential option. After ranking the options, respondents were asked how difficult it was to make their choices: very difficult, kind of difficult, not very difficult. Finally, an open-ended question was asked, "What guided you in making your choices?" Respondents' social workers were asked to rank same six residential options for each respondent. Chisquare and Kruskal-Wallis tests were computed for treatment groups-by-respondents' choices for first through sixth choice with no significance found. "Difficulty of Choice"by- treatment group analyses found no significance using Kruskal-Wallis test, and trend toward significance using chi-square. Content analysis of open-ended question, "What guided you ..• " yielded seven categories of answers, and chi-square of "What guided you"-by-respondents' first choice of residential setting was significant. "Experience" and "Privacy and Independence" were most influential factors from content analysis, but only trends toward significance were found in chi-square, cross-tabulating them by treatment group. Since cross-tabulation of respondents'-by-social workers' choices showed no significance, six rankings were collapsed into three and significance was found for supported housing option (respondents and social workers choosing it in common third or fourth) for total sample. Other significance was found in verbal treatment group for homeless shelter (chosen in common fifth or sixth), and for supported housing (chosen in common third or fourth). Rank correlations of respondents' and social workers' choices for total sample found significant negative relationship for room and board option. Rank correlations of choices by treatment group found significant negative relationship for room and board in the verbal treatment group; found significant positive relationship for residential care facility in the verbal/written treatment group; found significant negative relationship for room and board option in the verbal/written/visual treatment group. Abstraction deficits evidently do no affect the way chronically mentally ill persons choose residential options. The chronically mentally ill also do not find choosing a residential placement any more or less difficult given the presentation of written and visual descriptions in addition to verbal description. Given excess of "not very difficult" answers to "difficulty" question, validity of "difficulty" question to detect quality of choice process is questionable. Better outcome question may have been, "How satisfied are you with you choices?". Given distribution of respondents' and social workers' choices, compromise between independent living and residential care facility is suggested in choice of supported housing program.

Thesis (M. Soc. Sc.)--University of Hong Kong, 2003.

Thèse de doctorat : Psychologie. Psychologie et psychopathologie cliniques : Strasbourg 1 : 2008. / Titre provenant de l'écran-titre. Bibliogr. 53 p.. Index.

Thesis (Ph. D.)--Drexel University, 2004. / Includes abstract and vita. Includes bibliographical references (leaves 56-65).

Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references. Available also from UMI Company.

Introduction: The connection between self and psychosis has been qualitatively noted for centuries, but left relatively neglected in the field of quantitative psychology research. Some targeted studies have shown that self-concept is different in patients with psychosis than healthy volunteers. Studies of individuals have established a specific relationship between distortions of self and the content of delusions. Recent studies have begun to collect evidence of changes of self in the early stages of psychosis. Research suggests that delusions and self-concept have various shared cognitive mechanisms and neuroanatomy, particularly with respect to persecutory delusions. Changes in self-concept are apparent in persons at ultra high risk for developing psychosis, suggesting that it precedes specific symptomatology and could be at the root of delusion formation. Therefore, we identify where the two domains intersect while overcoming the limitations of past studies such as considering only persecutory delusions, minimally defining self, and including patients with a wide range of diagnoses. Methods: We consider delusions and self-concept in a patient group, consisting of 22 persons with first-episode schizophrenia spectrum disorders, and a group of 22 healthy volunteers. Delusional ideation is measured through the Peters et al Delusion Inventory (PDI) which derives a total, three subscores- Distress, Preoccupation, Conviction- and seven factor scores based on delusion content. Self-concept is quantified using hierarchical classification (HICLAS) analysis which generates numeric and visual outputs. It is important to specify that self is a deceivingly broad topic of which we will focus on the trait level- that is, which adjectives individuals use to describe their selves and others who are close to them. In addition to PDI and HICLAS evaluations, patients undergo clinical diagnoses and symptom ratings. Results: While there was no diagnostic group difference in the PDI total or subscores, patients had more delusional ideation with respect to three types of content, as determined by the factor scores. HICLAS did not show group differences. However, patients and controls had different relationships between PDI and HICLAS measures, with patients showing a greater overall connection between the two domains. The specific results are discussed, including two qualitative case studies. Conclusion: We conclude that the relationship between self-concept and schizophrenia is specific to delusions rather than general symptomatology. Relationships are drawn between the cognitive theories underlying each domain. The findings are important to theoretical understandings of self and delusions. Furthermore, it is hoped that advanced understanding of these topics can likely lead to new, targeted psychotherapeutic treatment approaches. / published_or_final_version / Psychiatry / Master / Master of Philosophy

Not available / text

published_or_final_version / abstract / toc / Psychiatry / Master / Master of Philosophy