published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

The empirical aim of this heuristic study was to explore the psychotherapeutic experiences of those with a ‘schizophrenia’ diagnosis. The epistemological aim was to deconstruct the structures of knowledge underpinning the diagnosis. The ‘personal knowledge’ drawn from the researcher’s own experience of working as a psychotherapist and filmmaker with individuals who had the diagnosis, and of being a psychiatric patient in the past, was used as a way of furthering these aims. Along with the work of Moustakas and Polanyi, key discourses used were Heidegger, Laing and contemporary critical clinical discourses. Eight participants with a ‘schizophrenia’ diagnosis took part in open-ended, conversational interviews that yielded substantial detail about the phenomenon. A multiperspective chronological narrative of early life experience, ‘schizophrenic’ breakdown, treatment and recovery emerged during the analysis of data, and is preserved in the composite depiction of the group experience. It was found that exploring the meaningfulness of experiences was a core driver of recovery, and psychotherapy was most helpful when it facilitated this exploration. By contrast, psychotherapy, and treatment as a whole, that obstructed this exploration were found unhelpful. These findings led to the argument that, what is termed ‘personal meaning’, may be a key factor in recovery from ‘schizophrenia’, and psychotherapy that was helpful seemed characterised by Heidegger’s concept of ‘anticipating care’. Treatment governed by ‘medical meaning’ and ‘intervening care’, meanwhile, are argued to prolong a crisis of ‘personal meaning’, and potentially facilitate an ‘acute’ phase of ‘schizophrenia’, rather than recovery. This conclusion raises critical questions about NICE guidelines for ‘schizophrenia’, which seem rooted in ‘medical meaning intervening care’. As well as facilitating an ‘understanding’ approach (in Heidegger’s sense) to researching experience, one key outcome arising from the researcher’s autobiographical connection to the research was learning more about his own experiences, and how to speak about them.

This study hypothesized that paranoid schizophrenia and schizo-affective, depressed type schizophrenia could be differentiated by the Internalizer-Externalizer, Regulated- Flexible, and Role Uniform-Role Adaptable dimensions of the Personality Assessment System. The Personality Assessment System methodology utilizes the Wechsler Adult Intelligence Scale to measure these dimensions. All hypotheses were statistically confirmed. The difficulty of applying the Personality Assessment System to psychopathological regressive states is cited. Recommendations include utilizing the Personality Assessment System with other groups in the institutional setting and within diagnostic categories.

Os sintomas negativos têm sido apontados como grande causa de sobrecarga nos pacientes esquizofrênicos, apesar dos recentes avanços no tratamento. Este estudo teve por objetivo investigar a correlação entre os sintoma s negativos e a qualidade de vida, em pacientes esquizofrênicos refratários e super-refratários. Cento e dois pacientes que preenchiam os critérios DSM-IV para esquizofrenia foram observados durante seis meses. Os pacientes foram divididos de acordo com critérios pré-estabelecidos, em três grupos: não refratários (N=22), refratários (N= 47) e super-refratários (N= 31), A psicopatologia foi avaliada por meio da Escala para Avaliação da Síndrome Positiva e Negativa (PANSS), Entrevista para Síndrome Deficitária (SDS) e Escala de Calgary para Depressão na Esquizofrenia. A qualidade de vida foi medida pela Escala de Qualidade de Vida (QV) . Os super-refratários tiveram os menores escores de QV, quando comparados ao grupo não refratário (p < 0,05). Não houve diferenças significativas nos escores médios de QV entre os refratários e superrefratários. Pacientes não refratários apresentaram menos sintomas negativos e melhores escores de QV. Os sintomas negativos tiveram uma correlação negativa com a qualidade de vida. Pacientes super-refratários, com mais sintomas negativos, tenderam a ter os menores escores de qualidade de vida / Negative symptoms have been reported as a major cause of burden in schizophrenic patients and often do not respond to drug treatment, in spite of recent advances in antipsychotic therapy. The present study aims to investigate the correlation of negative symptoms with quality of life in refractory schizophrenic patients. One hundred two outpatients meeting DSM-IV criteria for schizophrenia, were observed during 6 months. Subjects were divided into 3 groups: non-refractory (N=22), refractory (N= 47) and superrefractory (N= 31), according to pre-established criteria. Psychopatology was assessed with the Positive and Negative Syndrome Scale (PANSS), Schedule for Deficit Syndrome (SDS) and the Calgary Depression Scale for Schizophrenia. Quality of life was measured with the Quality of Life Scale (QoL). The super-refractory group had significantly lower QoL scores compared with the non-refractory group (P< 0,05). Mean QoL scores of superrefractory and refractory patients did not show a significant difference between them. Nonrefractory patients had fewer negative symptoms and better QoL scores. Negative symptoms negatively correlate with quality of life in schizophrenic patients. Superrefractory schizophrenic patients have the highest level of negative symptoms, and therefore the lowest QoL scores

Au Wing-cheong. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 73-91). / Abstracts in English and Chinese. / LIST OF ABBREVIATIONS --- p.i / ACKNOWLEDGEMENT --- p.ii / ABSTRACT --- p.iii / LIST OF TABLES --- p.vii / LIST OF FIGURES --- p.viii / LIST OF APPENDICES --- p.ix / Chapter CHAPTER I. --- INTRODUCTION --- p.1 / Chapter CHAPTER II. --- REVIEW OF THE LITERATURE --- p.3 / The construct of community living skills --- p.3 / Assessment tools for community living skills --- p.6 / The St. Louis Inventory of Community Living Skills --- p.9 / Prediction of community level-of-care --- p.12 / Training community living skills in Hong Kong --- p.15 / Chapter CHAPTER III. --- RATIONALE FOR THE STUDY --- p.17 / de-institutionalization movement and community living skills training --- p.17 / Lack of structured community living skills assessment toolsin Hong Kong --- p.20 / The choice of the SLICLS for cross-cultural validation --- p.21 / Chapter CHAPTER IV. --- GENERAL METHODOLOGICAL CONSIDERATIONS --- p.23 / An introduction to the test construction procedures --- p.23 / An outline of the cross-cultural validation process --- p.24 / Issues concerning reliability of rating scales --- p.26 / Issues concerning validity of rating scales --- p.28 / Chapter CHAPTER V. --- METHOD --- p.31 / Translation of the SLICLS --- p.31 / Content validity of the SLICLS-C --- p.32 / Inter-rater reliability of the SLICLS-C --- p.34 / Internal consistency of the SLICLS-C --- p.35 / Construct validity of the SLICLS-C --- p.36 / Concurrent validity of the SLICLS-C --- p.37 / Predictive validity of the SLICLS-C --- p.38 / Ethical considerations --- p.41 / Chapter CHAPTER VI. --- RESULTS --- p.43 / The SLICLS-C --- p.43 / Content validity of the SLICLS-C --- p.44 / Inter-rater reliability of the SLICLS-C --- p.46 / Internal consistency of the SLICLS-C --- p.48 / Construct validity of the SLICLS-C --- p.49 / Concurrent validity of the SLICLS-C --- p.52 / Predictive validity of the SLICLS-C --- p.54 / Chapter CHAPTER VII. --- DISCUSSION --- p.59 / Validity of the SLICLS-C --- p.59 / Reliability of the SLICLS-C --- p.62 / Accuracy of the SLICLS-C in predicting community level of care --- p.63 / Significance of the study --- p.65 / Limitations of the study --- p.67 / Recommendations for further studies --- p.69 / Chapter CHAPTER VIII. --- CONCLUSION --- p.70 / REFERENCES --- p.73 / APPENDICES --- p.92

While most people with schizophrenia face the functional consequences of a lifelong disorder, very few studies have investigated the specific domain of daily living activities performance. The purpose of this thesis was to examine the relationships between daily activity performance, cognitive deficits, and community functioning in people with schizophrenia. More specifically, the objectives were: 1) to describe functional limitations during daily task performance, 2) to explore the existence of subgroups of participants with similar functional limitations profiles, 3) to explore the relationships between daily task performance and cognitive functions as well as 4) with community functioning. This thesis tested the hypothesis that limitations in task performance negatively influence community functioning. / A sample of 82 individuals with schizophrenia and 28 healthy controls participated in this study and were assessed during a meal preparation task with the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis and on cognitive tests of visuospatial memory, spatial working memory, visuomotor coordination, planning and selective attention. Community functioning was assessed with the Independent living Skills Survey and the Multnomah Community Ability Scale. Limitations in the Perceive, Recall and Plan quadrants of the PRPP System, were found in participants with schizophrenia when compared to a control group (n = 28), as well as in the complete sample (n = 82). Participants in the high-efficiency subgroup ( n =36) were more independent in daily living and performed better on the visuospatial associative learning task than the low-efficiency subgroup (n = 46). At the specific level of individual profiles, participants were distributed along a continuum of low- to high-functioning on the PRPP System factors and on functional, cognitive, and clinical characteristics. / The associative learning task was most associated with task performance, along with working memory and planning. Finally, less efficient planning skills were associated with a lower level of community functioning, confirming the hypothesis. These results emphasize the relationship of associative visual memory to daily task performance, as well as that of efficiency in daily activities for residential status. Integrating these findings into the rehabilitation process will contribute to better meeting the needs of people with schizophrenia.

Os sintomas negativos têm sido apontados como grande causa de sobrecarga nos pacientes esquizofrênicos, apesar dos recentes avanços no tratamento. Este estudo teve por objetivo investigar a correlação entre os sintoma s negativos e a qualidade de vida, em pacientes esquizofrênicos refratários e super-refratários. Cento e dois pacientes que preenchiam os critérios DSM-IV para esquizofrenia foram observados durante seis meses. Os pacientes foram divididos de acordo com critérios pré-estabelecidos, em três grupos: não refratários (N=22), refratários (N= 47) e super-refratários (N= 31), A psicopatologia foi avaliada por meio da Escala para Avaliação da Síndrome Positiva e Negativa (PANSS), Entrevista para Síndrome Deficitária (SDS) e Escala de Calgary para Depressão na Esquizofrenia. A qualidade de vida foi medida pela Escala de Qualidade de Vida (QV) . Os super-refratários tiveram os menores escores de QV, quando comparados ao grupo não refratário (p < 0,05). Não houve diferenças significativas nos escores médios de QV entre os refratários e superrefratários. Pacientes não refratários apresentaram menos sintomas negativos e melhores escores de QV. Os sintomas negativos tiveram uma correlação negativa com a qualidade de vida. Pacientes super-refratários, com mais sintomas negativos, tenderam a ter os menores escores de qualidade de vida / Negative symptoms have been reported as a major cause of burden in schizophrenic patients and often do not respond to drug treatment, in spite of recent advances in antipsychotic therapy. The present study aims to investigate the correlation of negative symptoms with quality of life in refractory schizophrenic patients. One hundred two outpatients meeting DSM-IV criteria for schizophrenia, were observed during 6 months. Subjects were divided into 3 groups: non-refractory (N=22), refractory (N= 47) and superrefractory (N= 31), according to pre-established criteria. Psychopatology was assessed with the Positive and Negative Syndrome Scale (PANSS), Schedule for Deficit Syndrome (SDS) and the Calgary Depression Scale for Schizophrenia. Quality of life was measured with the Quality of Life Scale (QoL). The super-refractory group had significantly lower QoL scores compared with the non-refractory group (P< 0,05). Mean QoL scores of superrefractory and refractory patients did not show a significant difference between them. Nonrefractory patients had fewer negative symptoms and better QoL scores. Negative symptoms negatively correlate with quality of life in schizophrenic patients. Superrefractory schizophrenic patients have the highest level of negative symptoms, and therefore the lowest QoL scores

The problem of this study was to isolate a constellation of "signs" or items of behavior of individuals on the Bender-Gestalt test and to determine if these signs will discriminate significantly between one patient category, paranoid schizophrenia, and three other major diagnostic categories.

Neuropsychological tests have been used in differentially diagnosing schizophrenic and brain damaged populations. Research indicated some subgroups of schizophrenia exhibit certain symptoms of brain damage; and that schizophrenia involves difficulty in sensory integration. The Haptic Visual Discrimination Test (HVDT) designed to test tactilevisual integration, Bender Gestalt, and Information and Digit Symbol subtests of the WAIS were used to test performance abilities of forty schizophrenic subjects, forty subjects medically diagnosed as brain damaged (10 right hemisphere, 10 left hemisphere, and 20 diffuse), and normals as defined by the standardized age norm scores.

The specific objectives of this investigation are as follows: 1. To determine which half -- verbal half or performance half -- of the Wechsler-Bellevue Intelligence Test contributes most to total intelligence quotient for schizophrenics. 2. To determine whether any significant correlation exists between test scores and patterns of schizophrenics and normals. 3. To determine whether there exists any premature aging process in schizophrenics.