A presente dissertação é resultante da experiência em distintos espaços clínicos com pacientes psicóticos e, em especial, em oficinas terapêuticas de música. A escrita busca investigar os possíveis efeitos do trabalho com a música na clínica da psicose. Para tanto, a primeira parte do trabalho trata de entrar em compasso com o leitor, situando-o com relação àquilo que entendemos por estruturação psicótica desde a perspectiva psicanalítica. É desde essa mesma perspectiva que situamos o campo de experiência e o método da pesquisa. Nesse sentido partimos de duas questões principais: uma delas diz respeito à narração, enquanto possibilidade de transmissão da experiência do inconsciente; a outra, ao caráter ficcional do que se produz a partir da experiência clínica. Apoiados em Freud, principalmente através do texto Construções em Análise, de 1937, é que sustentamos a forma de apresentação do que intitulamos “Memórias da Clínica”. Três fragmentos da experiência clínica colocam em relação as questões centrais do trabalho: a clínica da psicose e a música. A primeira memória acontece em uma oficina de música, inserida em um CAPS da cidade de Porto Alegre. No dilúvio de palavras de Julia escutamos o aprisionamento à palavra do Outro e a possibilidade de que, através da música, o sujeito possa tomar a palavra, colocando-se mais em consonância com o tempo do Outro e dos outros A segunda, surgida em um acompanhamento terapêutico, nos coloca a seguinte pergunta: como calar o Outro? Aqui também foi através da música que essa possibilidade surgiu. E, finalmente, a terceira memória cujo contexto é a escuta individual de uma paciente em uma clínica-escola. Nessa cena a voz, enquanto puro objeto, assegura uma função de presença. As memórias nos levaram aos caminhos da constituição do sujeito. Tendo a psicose e a música como guias, nos aventuramos por um percurso de pesquisa que reuniu operadores conceituais essenciais na aposta de que um sujeito pode advir, tais como: pulsão invocante, o fort-da, o espelho, alíngua. Trabalhar com a espera e com a abertura de intervalos é um desafio constante na escuta de psicóticos. Em nossa experiência, a música mostrou-se uma via potente nesse trabalho de criar intervalos. Através das variações do objeto da pulsão invocante que a música coloca em jogo, a palavra pode voltar a circular. Dar a palavra ao sujeito: não é disso que se trata na psicanálise? E que efeitos pode ter a música nessa operação? Dessa análise decanta a questão do silêncio, enquanto um elemento essencial na direção do tratamento nas psicoses. / The present dissertation is the result of trials in different clinical spaces with psychotic patients and, especially, in therapeutical music workshops. The writing seeks to investigate the possible effects of the work with music in the psychosis clinic. For such, the first part of the work tries to explain the reader, what we understood as a psychotic structuring under the psychoanalytic perspective. It is from that same perspective that we explain the field of experience and the research method. In that sense, we start from two main subjects: one of them concerns the narration, as a possibility of transmission of the unconscious experience; the other, the ficcional character that is produced starting from the clinical experience. Based on Freud, mainly through the Constructions in Analysis text, from 1937, we sustain the presentation form entitled “Memoirs of the Clinic.” Three fragments from the clinical experience which relate the central subjects of the work: the psychosis clinic and music. The first memory happens at a music workshop, inserted in a CAPS (Psycho-social Service Center) of the city of Porto Alegre. In the flood of Julia´s words we heard the imprisonment to the word of the Other and the possibility that, through music, the subject may take the word, becoming more in consonance with the time of the Other and the other ones. The second, appeared in a therapeutic assistance, places the following question: how to silence the Other? Here it was also through music that this possibility appeared. And, finally, the third memory whose context is the individual listening of a patient in a school clinic. In that scene, the voice, as a pure object, takes a presence function. The memoirs took us to the paths of the constitution of the subject. Taking the psychosis and the music as guides, we ventured in that primordial operation, through subjects as the invoking pulsion, fortda, the mirror, the language: essential concepts and operations in the hope that a subject may come. To work with the waiting and with the opening of intervals is a constant challenge in the listening of psychotics. In our experience, the music has appeared as a potent path in that work of creating intervals. Through the variations of the object of the invoking pulsion that the music turns on, the word circulates again. To give the word to the subject: isn’t that dealt with in psychoanalysis? And what effects may the music have in that operation? From that analysis upsurges the subject of silence, as an essential element in the direction of the psychoses treatment.

In the Philippines, amok is often viewed as a form of homicidal behaviour to which Muslim Filipino or Moro men are prone. Various assumptions about contemporary Filipino perceptions of amok are challenged in this thesis. It is assumed that this perception corresponds with the actual occurrence of amok in the Philippines, and this is challenged by the demonstration that the perception is merely a construct. The perception of amok is assumed to be the culmination of attempts by Spaniards, Americans and Filipinos to discern the true nature of amok, and this is challenged by the fact that discrepancies exist between recognition of amok by the Spanish on one hand and the Americans and Christian Filipinos on the other. It is argued that contemporary Filipino understanding of amok is the product of two factors: the American drive to acquire information about Filipinos that would enable them to control their newly acquired subjects, and the conflict between Americans and Filipinos generated by this attempt at control. The association of amok with Muslim Filipinos is the outcome of the mistaken conflation of amok with the juramentado convention of the Moros, and the idea that the Muslim Filipinos were the most Malay of the Malay ‘subraces’ in the Philippines and thus most likely to run amok. / Doctor of Philosophy (PhD)

Thesis (Ph. D.)--University of Chicago, Department of Germanic Languange, March 2001. / Includes bibliographical references. Also available on the Internet.

Texte extrait de : Thèse de doctorat : Psychopathologie clinique et psychanalyse : Paris VII : 1981. / Notes bibliogr.

The experience of psychosis (e.g. threatening symptoms such as persecutory delusion and terrifying hallucinations) and its treatment (e.g. coercive measures such as involuntary admission and seclusion) are distressing. In view of the potential severity of the distress associated with psychosis, previous research has applied the trauma model to understand the experience of psychosis and its treatment and found that 11-67% of psychotic patients presented with clinically significant PTSD reactions in response to their psychosis and treatment experience. This phenomenon is termed as post-psychotic PTSD (PP-PTSD). However, previous research generally failed to find consistent relationship between PP-PTSD reactions and objective psychotic and treatment experiences (except for positive psychotic symptoms). Cognitive conceptualization of PTSD opines that it is the cognitive appraisal of the traumatic event, rather than the trauma per se, that is related to the development of PTSD. The present study aims to contribute to a better understand of PP-PTSD through a cognitive perspective. The present study applies Ehlers and Clark’s cognitive model of PTSD in understanding PP-PTSD. It explores the roles of fear of relapse and perceived risk of relapse, attribution of the causes of psychosis, perceived stigma and rejection and perceived consequence of the psychotic illness in PP-PTSD. The present study was a cross-sectional study and recruited 38 patients with schizophrenia-spectrum disorders. Semi-structured interview was used to determine whether the patients met the PP-PTSD diagnosis. The patient’s positive psychotic symptoms and social and occupational functioning were assessed by semi-structured interview while their PP-PTSD symptoms, trauma history and cognitive appraisals were measured using self-report questionnaires. Results showed that 15.8% of patients meet the full criteria of PP-PTSD and more than 50% of patients demonstrated some PP-PTSD reactions, which provides support for the application of the PP-PTSD construct in the local context. Treatment experiences were found to induce more severe PP-PTSD reactions than psychotic experience. Cognitive appraisals were found to be associated with PP-PTSD and there was some support for the application of Ehlers and Clark’s model in PP-PTSD. Specially, the present study found that fear of relapse, higher perceived risk of relapse, perceived helplessness and self-blame of causing the onset of psychosis, stable attribution of the cause of psychosis onset, perceived stigma, perceived large and chronic consequence of psychosis were all associated with more severe PP-PTSD reactions. Fear of relapse was also found to predict PP-PTSD severity. Clinical implications on the prevention, assessment and treatment with reference to the present results are discussed. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Objectives: The study investigates the effects of different Chinese translations for psychosis on perceptions of youth service providers. The hypothesis is youth service providers believe that to have better understanding and acceptance in name si-jue-shi-tiao rather than others. Participants and methods: 100 youth service providers were recruited and interviewed with 34-item questionnaires. They were presented with a vignette describing a person with jing-shen-fen-lie-zheng/ si-jue-shi-tiao/ jing-shen-bin. Belief of cause, benevolence, separatism, stereotyping, restrictiveness, pessimistic prediction and stigmatization of different labeling were investigated. Results: The study found that si-jue-shi-tiao group has less stigmatization effect compared with jing-shen-fen-lie-zheng group and Jing-shen-bin group but the psychiatric labeling has no statistically significant effect on benevolence, separatism, stereotyping, restrictiveness, pessimistic prediction. Conclusion: The study supported renaming psychosis has an improvement on stigmatization, but not obviously seen to have improvement in the other attitudinal dimensions. People who have religious belief, profession in occupation, having previous contact with people (e.g. friend and client) who have mental illness indeed affected to have positive effect on their views towards person with psychosis. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Patients with psychosis comprise a high-risk group in terms of suicide behaviors especially in the early phases. Suicide ideation on the other hand acts as the starting point along the chain of suicide. However less is known about suicide ideation among patients at their first-episode psychosis (FEP). Present study investigated contributing factors in suicidal ideation among FEP patients in Hong Kong. FEP outpatients (N=20) and normal controls (N=20) were invited to complete a set of self-assessment questionnaires. These questionnaires measured a wide range of potential risk factors including hopelessness, impulsiveness, reasons for living, insight, drug-attitude and treatment satisfaction. Results showed that patients have a higher occurrence-rate of suicide ideation (45%) compared to patients without ideation. Ideators were significantly more hopeless, impulsive, more aware of their illness and having fewer survival & coping beliefs. Taken together, current study extended the stress-diathesis model in explaining suicidal behaviors among psychotic patients. We also demonstrated that insight in patients plays a role in interacting with suicide ideation. Further, since hopelessness appeared to be the strongest associative factor among all, this study has implications on prevention work focusing on hope maintenance. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Background / Objectives: Mental diseases are perceived as one of the highest stigmatised conditions in our society. Public knowledge of mental illness does not come from professional journals or medical authorities, but largely from mass media as it is a major and most convenient source of information. Media tends to portray mental illness with negative attitude, focusing on bizarre and unexplainable behaviours of patients with mental illness, and exaggerating the linkage between mental illness and aggressive behaviours. However, few studies have been conducted in Hong Kong focusing on media perspective on this. This study focuses on the research of media’s role on psychosis from the perspective and experience of media professionals, and to identify media’s functional role of whether it is fostering public awareness and reducing stereotypes towards psychosis or on the contrary intensifying stigma conditions in the community of Hong Kong. Methodology: This is a qualitative study that purposive sampling method was used to recruit 22 media professionals from various media background including news media, entertainment and creative media, as well as public service broadcasting. All participants had up to one hour’s face-to-face in-depth interview based on pre-set theme of area of discussion. Results: Majority of subjects is able to recognise psychosis symptoms such as hallucination and (mainly persecutory) delusions, but unknown factors and myths about psychosis are still existed among the subjects. Confusion between psychosis, multiple personality disorders and even psychopath is commonly observed. Suggesting that media portrayal on psychosis and other mental illnesses is instilled with negative and stigmatised attitude is not prevalent. Most subjects believe that local news media can still perform with a neutral attitude when reporting the issues related to psychosis and mental illness. However, insufficient exposure of discussion about the topic across media platforms may affect public accessibility on the knowledge of psychosis and mental illness. Anti-stigma programs can contribute mostly positive messages and images about psychosis, but quality and quantity of those programs and promotions have to be designed and planned in delicate and persistent manners so as to maximise the effectiveness. Conclusion: Media plays a constructive role in educating the public about mental illness, and can also perpetuate stereotype and undermine the efforts of public campaigns. Suggesting that media practitioners are recommended to learn more about the well-round knowledge of psychosis and mental illness issue. Indeed, increased communication between media and mental health agencies can benefit the mutual understanding and lead to cooperative approach to tackle social stigma against psychosis. Though media professionals agree that media has its own limitation in terms of highly competitive broadcasting time and editorial space, most suggested that envisioned educational plan is an essential and influential method in removing public stigma and stereotype about psychosis. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Early intervention in psychosis emerged in the 1980s and has gradually become a new paradigm in mental health service worldwide. Yet, very few studies on the history of early intervention in mental illness exist even to date. This dissertation explored the situation in 19th century England when Britain was the only superpower in the world and at the same time was plagued by the rising number of insanity cases that she could only cope with by building more and bigger asylums. The idea of early treatment of insanity was found in various publications written by different physicians in the first half of 19th century. A few of them also proposed primary preventive measures as they believed that a good and disciplined life style could help to avoid the illness. They also saw that insanity could be hereditary. Meanwhile, the debate over the nature of insanity whether it is purely biological or goes beyond the physical body was happening in England as in continental Europe. The physicians supporting the idea of early intervention were also those who subscribed to the theory that insanity has a biological origin. The staging concept in the development of mental illness was well conceived by some physicians. There were also attempts to identify the symptoms in incipient insanity which is close to the modern concept of prodromal stage. Some medical professions also put forward detailed theories on the pathology of the illness based on their knowledge on brain physiology and its interaction with other organs of the body. During this period, professionalization of psychiatrists was advancing. In this process, there was clash between two schools of thoughts. One considered that the profession should move along a scientific path while the other considered that more effort should be devoted to pragmatic issues such as those concerning asylum management. This conflict had in some way hindered the advancement of early treatment. Another major obstacle to the provision of early treatment was the distrust of the society towards psychiatrists. After a number of notorious cases involving people being wrongly confined in the asylums had been widely publicized, the law was tightened to limit the authority of psychiatrists in certifying insanity and in treating uncertified cases. This had resulted in a serious blockade on the road to early treatment. Stigmatization of mental illness in the society was also a major factor in deterring people from seeking early assistance. From the experience in 19th century England, it was found that medicalization of mental illness, professionalization of psychiatrists, establishment of mutual trust between psychiatrists and the society, as well as de-stigmatization of mental illness would be conducive to the development of an early intervention paradigm. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Background: A study of the impact of yoga and aerobic exercise and psychosis was conducted in 2012 by Lin et al., from The University of Hong Kong. The study indicated significant improvement in the aspects of physical fitness, cognitive functions, psychosocial and emotional functioning in patients with psychosis after a 12-week yoga or aerobic intervention program. Long-term effect of exercise intervention, however, had yet been determined. The aim of the present study was to evaluate the long-term effects of yoga and aerobic exercise on cognitive functioning and clinical symptoms in early psychosis. Patients who originally participated in Lin et al.’s 2012 study were recruited and re-assessed in this current 18-month follow-up study. Methods: Two intervention groups (yoga and aerobic exercise group) and one control group (wait-list control group) of a total 57 subjects from the initial study were recruited in this follow-up study. Cognitive functioning and clinical symptoms were assessed at three time points (T1:Baseline, T2:12-week, T3:18-month). Results: No significant changes or significant deterioration were found in cognitive functioning, clinical symptoms and depression between T2 (12-week) and T3 (18-month) in both intervention groups (yoga and aerobic group). Significant improvement of clinical symptoms was observed in wait-list control group at T3. Conclusions: Although there is no significant finding in this current study, it is still recommended that further study on the relationship between physical exercise intervention and psychosis should carried out in order to explore other adjunct, and especially low cost, treatment to antipsychotics in treating people with psychosis. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine