La psychose se caractérise par d’importants déficits cognitifs limitant le fonctionnement et le rétablissement des patients. La mémoire de source, permettant l’identification de l’origine du souvenir, est atteinte tout au long du continuum d’évolution de la psychose : du risque génétique à la chronicité de la maladie. Les troubles de mémoire de source seraient également reliés à la présence et la gravité des symptômes psychotiques. Ainsi, des auteurs soulèvent l’hypothèse selon laquelle la mémoire de source serait un précurseur cognitif de la psychose et donc, une cible potentielle d’intervention précoce. Pourtant, les connaissances actuelles concernant l’intervention sur la mémoire de source dans les troubles psychotiques restent limitées, justifiant l’importance de dresser un premier portrait des interventions pertinentes pour moduler ces processus. Le présent mémoire doctoral vise dans un premier temps, à relever les études portant sur des interventions non pharmacologiques ayant évalué l’effet sur la mémoire de source en début d’évolution de psychose et dans un deuxième temps, à discuter de celles démontrant une amélioration de son fonctionnement. Une recension systématique a permis d’identifier treize études, dont trois interventions bénéfiques soit, le programme d’entraînement de la mémoire autobiographique REMAu, le programme d’entraînement métacognitif MST, ainsi que la stimulation magnétique transcrânienne répétée de la jonction temporo-pariétale. Ce mémoire présente une réflexion clinique et des recommandations afin de guider les interventions en début d’évolution de psychose et les futures études sur le développement de programmes ciblant la mémoire de source. / Psychosis is characterized by severe cognitive deficits that prevent functional recovery. Source memory, allowing the retrieval of contextual details characterizing the origin of memories, is shown to be altered all along the continuum of psychosis from asymptomatic to chronic stages. The source memory impairments are also associated with the presence and severity of the psychotic symptoms. Thus, previous studies suggest that source memory could be considered as a cognitive precursor of psychosis and a relevant target of intervention in early course of the pathology. There is an actual need to further our knowledge on the rehabilitation of source memory in early psychosis. It may be necessary to first draw a portrait of available interventions that can modulate source memory processes. This thesis aims to systematically review studies on non-pharmacological interventions in early course of psychosis which reported outcomes on source memory and then, to identify different interventions which support its functioning. A systematic review identified thirteen studies, from with three revealed a significant effect on source memory. Two programs which trained memory and metamemory, the Autobiographical Reminiscence Therapy (REMAu) and the Metacognitive Training (MST), as well as repetitive transcranial magnetic stimulation of temporoparietal junction appeared beneficial. This thesis presents encouraging findings on the impact of available interventions on source memory. Preliminary clinical recommendations are provided on effective intervention for source memory impairments in the early course of psychosis as well as guidance for the development of source memory intervention programs.

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

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