O primeiro episódio psicótico (PEP) é um período marcado por uma série de mudanças na dinâmica familiar. A família tem um papel importante no processo de tratamento desses pacientes. As atitudes dos membros familiares acerca do paciente são avaliadas por meio dos níveis de Emoção Expressa (EE) e de sobrecarga familiar. Apesar da importância do papel dos cuidadores, estudos conduzidos para avaliar as relações intrafamiliares de pacientes no PEP são escassos. Este estudo observacional teve como objetivo determinar os fatores relacionados aos níveis de EE e sobrecarga de familiares de pacientes no PEP. Participaram do estudo 100 familiares e 100 pacientes em acompanhamento em um ambulatório de um hospital universitário do interior do Estado de São Paulo, no período de janeiro de 2015 a janeiro de 2016. Para a coleta de dados foram utilizados quatro instrumentos: um formulário contendo dados sociodemográficos e clínicos, o Family Questionnaire - Versão Português do Brasil (FQ-VPB) para avaliar os níveis de EE e de seus domínios Comentários Críticos (CC) e Superenvolvimento Emocional (SEE), o Inventário de Sobrecarga do Cuidador (ISC) para medir os níveis de sobrecarga dos familiares e a Medida de Adesão aos Tratamentos (MAT) para avaliar a adesão ao tratamento. Os dados foram obtidos por meio de entrevista dirigida. Para análise utilizou-se estatística descritiva e regressão logística múltipla. O nível de significância adotado foi de 0,05. Quanto aos resultados, a maioria dos familiares (62%) foi classificada com elevado nível de EE, 63% com baixo nível de CC, 59% com elevado nível de SEE e 43% apresentaram nível moderado de sobrecarga familiar. Em relação à adesão ao tratamento, 84% dos pacientes foram considerados aderentes. Houve associação significante entre os níveis de EE, SEE e o sexo e escolaridade dos familiares, entre o vínculo com o paciente e os níveis de EE, SEE e CC, entre os níveis de sobrecarga e o diagnóstico médico e entre a idade do paciente e os níveis de CC. Além disso, houve associação significante entre os níveis de EE, SEE e CC e os níveis de sobrecarga. A análise do modelo multivariado mostrou que os anos de estudo do familiar foram considerados fatores de proteção para o desenvolvimento de níveis elevados de EE e SEE, enquanto os anos de estudo do paciente foram considerados fatores de proteção para sobrecarga moderada. Outro fator de proteção identificado foi o tipo de vínculo com o paciente, ou seja, ser pai, avós, sobrinhos, primos, tios ou colegas, representa fator de proteção para nível elevado de EE, CC e sobrecarga moderada, moderada a severa e severa. Por outro lado, familiares do sexo feminino apresentaram 4,81 vezes mais chance de apresentar nível elevado de SEE do que familiares do sexo masculino. Além disso, familiares de pacientes com diagnóstico de esquizofrenia tem 4,19 vezes mais chance de apresentar nível elevado de CC do que familiares de pacientes sem diagnóstico. Espera-se que esses resultados possam fornecer informações para elaboração de estratégias de prevenção e promoção em saúde mental que envolvam os pacientes no PEP e seus familiares / The first-episode psychosis (FEP) is a period marked by a series of changes in family dynamics. Family plays an important role in the treatment of these patients. The attitudes of family members about the patient are evaluated by the levels of Expressed Emotion (EE) and family burden. Despite the importance of the role of caregivers, conducted studies to assess the intra-family relationships of patients in the FEP are scarce. This observational study aimed to determine the factors related to EE levels and relatives to FEP patients overwhelmed. The study included 100 families and 100 patients followed up in a clinic of a university hospital in the state of São Paulo, from January 2015 to January 2016. For data collection were used four instruments: a form containing sociodemographic and clinical data; the Family Questionnaire - Brazil\'s Portuguese version (FQ-BPV) to measure the EE levels and its domains of Criticism and emotional overinvolvement (EOI); the Zarit Burden Interview (ZBI) to measure the overload levels of family members and the Measurement of Treatment Adherence (MTA) to evaluate adherence to treatment. The data were obtained by guided interview. For analysis, it was used descriptive statistics and multiple logistic regression. The significance level was 0.05. As the results, most families (62%) were classified with high level of EE, 63% with low criticism, 59% with high level of EOI and 43% had moderate level of family burden. In relation to adherence to treatment, 84% of patients were considered adherent. There was a significant association between EE levels, EOI and the gender and education of family members, between the relationship with the patient and EE levels, EOI and criticism, between the burden levels and the medical diagnosis and between the age of the patient and criticism levels. In addition, there was a significant association between EE levels, EOI and criticism and burden levels. The analysis of the multivariate model showed that the years family study were considered protective factors for the development of high levels of EE and EOI, while the years of patient study were considered protective factors to moderate overwhelm. Another protection factor identified was the type of relationship with the patient. Having another relation with the patient, ie, being a father, grandparents, nephews, cousins, uncles or colleagues, is a protective factor for high level of EE, criticism and moderate overload, moderate to severe and severe. By contrast, female members of the family had 4.81 times more likely to have high level of EOI that those family members who were male. In addition, relatives of patients with schizophrenia has 4.19 times more likely to have high levels of criticism than relatives of patients who do not have diagnosis. It is expected that these results can provide information for developing prevention strategies and promotion on mental health involving patients in the FEP and their families

Existem evidências de que as manifestações psicóticas não são vivenciadas apenas por pessoas diagnosticadas com transtornos mentais, mas também por pessoas saudáveis da população geral, as denominadas experiências tipo-psicóticas. A Escala de Avaliação das Experiências Psíquicas na Comunidade (CAPE) é um instrumento usado em pesquisas epidemiológicas e foi desenvolvido especificamente para a detecção e avaliação da frequência de experiências tipo-psicóticas na população geral. A CAPE, em sua apresentação original é composta por 42 itens, distribuídos em três dimensões: positiva, negativa e depressiva. O objetivo deste estudo foi verificar as evidências de fidedignidade e validade da CAPE em uma amostra brasileira e investigar a associação de traumas na infância e uso de cannabis com a ocorrência de experiências tipo-psicóticas em indivíduos da população geral. A amostra foi composta por 217 pacientes em primeiro episódio psicótico, 104 irmãos de pacientes psicóticos e 319 controles de base populacional, todos residentes na área de cobertura do Departamento Regional de Saúde do Estado de São Paulo (DRS XIII). Os participantes responderam a instrumentos de avaliação e diagnósticos, incluindo a Entrevista Clínica Estruturada para o DSM IV (SCID), o Questionário sobre Traumas na Infância (CTQ), Questionário de Experiências com Maconha (CEQ), além da CAPE. Os dados clínicos foram analisados por meio do pacote estatístico SPSS e as evidências psicométricas por meio do software AMOS. Após a retirada de nove itens, a CAPE, com 33 itens, mostrou bons índices de ajustamento [CFI = 0,895; GFI = 0,822; PGFI = 0,761; RMSEA = 0,055 p (rmsea <= 0,05) = 0,04] e boa consistência interna (> 0,70) em todos as suas dimensões. Nas análises realizadas apenas com a amostra de base populacional, não foram encontradas diferenças significativas entre as pontuações totais da CAPE-33 e das suas três dimensões quanto a intervalos de idade, estado civil e escolaridade. Mulheres apresentaram pontuações significativamente mais elevadas do que os homens no escore total (p<0,001) e nas dimensões negativa (p < 0,001) e depressiva (p < 0,001). A vivência de traumas na infância (abuso emocional, abuso físico, abuso sexual, negligência emocional, negligência física) associou-se com pontuações mais elevadas no escore total da CAPE (p <0,001) e nas suas três dimensões (positiva p = 0.001, negativa p = 0,004, depressiva p < 0,001). Indivíduos que relataram uso de cannabis alguma vez na vida apresentaram maiores pontuações na dimensão positiva da CAPE-33, em comparação às pessoas que nunca usaram a substância (p = 0,016). A CAPE adaptada para o Brasil (CAPE-33) mostrou bons índices de ajustamento e consistência interna, como encontrado em outras culturas. Presença de trauma precoce e uso de cannabis associaram-se à ocorrência de experiências tipo-psicóticas, à semelhança do que os estudos epidemiológicos mostram para a esquizofrenia. Nossos dados corroboram a abordagem dimensional das psicoses, com frequência e gravidade das manifestações se distribuindo num continnum na população geral. / There is evidence that psychotic manifestation is not experienced only by people diagnosed with mental disorders but also by healthy people in the general population, known as psychotic-like experiences. The Community Assessment Psychic Experiences (CAPE) is an instrument used in epidemiological research and was developed specifically for the detection and evaluation of the frequency of psychotic-like experiences in the general population. The CAPE, in its original submission, is composed of 42 items, distributed in three dimensions: positive, negative and depressive. The objective of this study was to verify the evidence of reliability and validity the CAPE in a brazilian sample and to investigate the association of childhood traumas and cannabis use with the occurrence of psychotic-like experiences in individuals of the general population. The sample consisted of 217 patients in the first psychotic episode, 104 siblings of psychotic patients and 319 population-based controls, all residents in the coverage area of the São Paulo Regional Health Department (DRS XIII). Participants responded to assessment and diagnostic tools, including the Structured Clinical Interview for DSM IV (SCID), the Childhood Trauma Questionnaire (CTQ), the Cannabis Experience Questionnaire (CEQ), and CAPE. Clinical data were analyzed using SPSS statistical package and the psychometric evidence using AMOS software. After the removal of nine items, CAPE, with 33 items, showed good adjustment indices [CFI = 0.895; GFI = 0.822; PGFI = 0.761; RMSEA = 0.055 p (rmsea <= 0.05) = 0.04] and good internal consistency (> 0.70) in all its dimensions. In the analyzes performed only with the population-based sample, no significant differences were found between the CAPE-33 total scores and its three dimensions regarding age, marital status and schooling intervals. Women presented scores significantly higher than men in the total score (p <0.001) and in the negative (p <0.001) and depressive (p <0.001) dimensions. The experience of childhood traumas (emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect) was associated with higher scores in the CAPE total score (p <0.001) and its three dimensions (positive p = 0.001, negative p = 0.004, depressive p <0.001). Individuals who reported cannabis use in their lifetime had higher scores in the positive dimension of the CAPE-33 compared to people who had never used the substance (p = 0.016). The CAPE adapted to Brazil (CAPE-33) showed good adjustment indices and internal consistency, as found in other cultures. Presence of early trauma and use of cannabis were associated with the occurrence of psychotic-like experiences, in accordance with what epidemiological studies show for schizophrenia. Our data corroborate the dimensional approach of the psychoses, with frequency and severity of the manifestations being distributed in a continnum in the general population.

Pessoas com transtornos psicóticos enfrentam mudanças e limitações na vida cotidiana. Suas necessidades podem ser complexas e envolver vários tipos e níveis de cuidados. A avaliação sistemática das necessidades de usuários dos serviços de saúde é importante para a organização dos serviços e para estabelecer propostas individualizadas de tratamento. A avaliação de necessidades de usuários de serviços de saúde mental tem sido utilizada em vários países, mas ainda não é rotineira no Brasil. A CAN avalia necessidades em 22 domínios que envolvem diversas necessidades de ajuda, como problemas com moradia, alimentação, sintomas psicóticos, saúde física e outros. OBJETIVOS: Traduzir e adaptar a versão brasileira da CAN para pesquisa (CAN-R), e avaliar a sua confiabilidade entre avaliadores, em uma amostra de casos incidentes de psicoses funcionais na cidade de São Paulo. MÉTODO: Foram selecionados aleatoriamente participantes do \"Estudo de casos incidentes (primeiro contato com serviços de saúde) de psicoses funcionais no Brasil\", no qual este estudo está inserido. Os critérios de inclusão foram: contato pela primeira vez com serviços de saúde no período do estudo, diagnóstico de esquizofrenia, outras psicoses do espectro da esquizofrenia, mania ou depressão psicótica (DSM-IV); idade entre 18 e 64 anos; residir em determinadas regiões geográficas da cidade de São Paulo. A versão da CAN, traduzida e adaptada para o português pelo grupo de pesquisadores do estudo de casos incidentes, foi aplicada aos participantes do estudo por cinco auxiliares de pesquisa. Posteriormente um avaliador cego em relação às avaliações realizadas pelos auxiliares de pesquisa realizou a pontuação da escala de modo independente, utilizando fitas com a gravação das entrevistas. As pontuações das entrevistas realizadas pelos assistentes de pesquisa foram comparadas com as pontuações do avaliador independente utilizando-se o coeficiente kappa e o coeficiente de correlação intraclasse (CCI). RESULTADOS: Cinqüenta e dois sujeitos foram incluídos no estudo. Cinqüenta e dois por cento eram mulheres, a maioria dos participantes estava na faixa etária entre 18 e 39 anos, tinha no máximo oito anos de estudo e diagnósticos de esquizofrenia ou outros transtornos mentais do espectro da esquizofrenia. A confiabilidade entre avaliadores para os 22 domínios da escala foi substancial, quase perfeita ou total para 19 (87%) domínios. A confiabilidade para o total de necessidades, avaliada através do ICC, foi 0,95 (IC95% 0,90 - 1,00). CONCLUSÕES: A CAN mostrou boa aplicabilidade e reprodutibilidade segundo avaliação de profissionais de saúde mental com indivíduos em um primeiro episódio psicótico. O uso de instrumentos padronizados como a CAN em serviços de saúde mental no Brasil deve contribuir para a avaliação da efetividade das ações e para o cuidado individualizado das pessoas com transtornos mentais. / People with psychotic disorders usually face changes and limitation in their daily life activities. Their needs are complex and involve different types and levels of care. In several countries, the systematic assessment of needs is considered essential for service planning and to establish treatment goals. However, in Brazil, the assessment of needs is still limited. The Camberwell Assessment of Needs (CAN) assess needs in 22 domains that encompass a wide range of needs of care, as problems with accommodation, food, psychotic symptoms, physical health, and others. OBJECTIVES: The aims of this study were to translate and adapt the CAN for research (CAN-R) and to assess its inter-rater reliability, in a sample of first contact psychosis in São Paulo. METHOD: Subjects were randomly selected from the \'Brazilian First Contact Psychosis Study\' sample. The inclusion criteria were: first contact with health services due to a psychotic episode at the study period; diagnosis of schizophrenia, other psychotic disorders of schizophrenia spectrum, mania or psychotic depression (DSM-IV); age between 18 and 64 years; living in pre-defined areas of São Paulo. Five research assistants carried out the CAN version, adapted and translated into Portuguese by the investigators? group of the incidence study. Afterwards a blind investigator carried out the assessment independently, through tape-records of the interviews. Kappa coefficient and intraclass correlation coefficient were used to compare ratings of the independent investigator with ratings of the research assistants group. RESULTS: Fifty-two subjects were included, 27 (52%) of them were women. Most were in 18-39 age group, had studied eight years or less, and had diagnosis of schizophrenia or other schizophrenia spectrum disorders. Inter-rater reliability to 19 (87%) domains was substantial, almost perfect or total as measured by kappa coefficient. Reliability to total of needs measured by ICC was 0.95 (CI 95% 0,90 - 1,00). CONCLUSIONS: The Can showed good applicability and reliability with first contact psychotic individuals. The use of standardized instruments as the CAN in mental health services in Brazil, can contribute to the assessment of effectiveness of interventions, and individualized care to people with mental disorders.

Pessoas com transtornos psicóticos enfrentam mudanças e limitações na vida cotidiana. Suas necessidades podem ser complexas e envolver vários tipos e níveis de cuidados. A avaliação sistemática das necessidades de usuários dos serviços de saúde é importante para a organização dos serviços e para estabelecer propostas individualizadas de tratamento. A avaliação de necessidades de usuários de serviços de saúde mental tem sido utilizada em vários países, mas ainda não é rotineira no Brasil. A CAN avalia necessidades em 22 domínios que envolvem diversas necessidades de ajuda, como problemas com moradia, alimentação, sintomas psicóticos, saúde física e outros. OBJETIVOS: Traduzir e adaptar a versão brasileira da CAN para pesquisa (CAN-R), e avaliar a sua confiabilidade entre avaliadores, em uma amostra de casos incidentes de psicoses funcionais na cidade de São Paulo. MÉTODO: Foram selecionados aleatoriamente participantes do \"Estudo de casos incidentes (primeiro contato com serviços de saúde) de psicoses funcionais no Brasil\", no qual este estudo está inserido. Os critérios de inclusão foram: contato pela primeira vez com serviços de saúde no período do estudo, diagnóstico de esquizofrenia, outras psicoses do espectro da esquizofrenia, mania ou depressão psicótica (DSM-IV); idade entre 18 e 64 anos; residir em determinadas regiões geográficas da cidade de São Paulo. A versão da CAN, traduzida e adaptada para o português pelo grupo de pesquisadores do estudo de casos incidentes, foi aplicada aos participantes do estudo por cinco auxiliares de pesquisa. Posteriormente um avaliador cego em relação às avaliações realizadas pelos auxiliares de pesquisa realizou a pontuação da escala de modo independente, utilizando fitas com a gravação das entrevistas. As pontuações das entrevistas realizadas pelos assistentes de pesquisa foram comparadas com as pontuações do avaliador independente utilizando-se o coeficiente kappa e o coeficiente de correlação intraclasse (CCI). RESULTADOS: Cinqüenta e dois sujeitos foram incluídos no estudo. Cinqüenta e dois por cento eram mulheres, a maioria dos participantes estava na faixa etária entre 18 e 39 anos, tinha no máximo oito anos de estudo e diagnósticos de esquizofrenia ou outros transtornos mentais do espectro da esquizofrenia. A confiabilidade entre avaliadores para os 22 domínios da escala foi substancial, quase perfeita ou total para 19 (87%) domínios. A confiabilidade para o total de necessidades, avaliada através do ICC, foi 0,95 (IC95% 0,90 - 1,00). CONCLUSÕES: A CAN mostrou boa aplicabilidade e reprodutibilidade segundo avaliação de profissionais de saúde mental com indivíduos em um primeiro episódio psicótico. O uso de instrumentos padronizados como a CAN em serviços de saúde mental no Brasil deve contribuir para a avaliação da efetividade das ações e para o cuidado individualizado das pessoas com transtornos mentais. / People with psychotic disorders usually face changes and limitation in their daily life activities. Their needs are complex and involve different types and levels of care. In several countries, the systematic assessment of needs is considered essential for service planning and to establish treatment goals. However, in Brazil, the assessment of needs is still limited. The Camberwell Assessment of Needs (CAN) assess needs in 22 domains that encompass a wide range of needs of care, as problems with accommodation, food, psychotic symptoms, physical health, and others. OBJECTIVES: The aims of this study were to translate and adapt the CAN for research (CAN-R) and to assess its inter-rater reliability, in a sample of first contact psychosis in São Paulo. METHOD: Subjects were randomly selected from the \'Brazilian First Contact Psychosis Study\' sample. The inclusion criteria were: first contact with health services due to a psychotic episode at the study period; diagnosis of schizophrenia, other psychotic disorders of schizophrenia spectrum, mania or psychotic depression (DSM-IV); age between 18 and 64 years; living in pre-defined areas of São Paulo. Five research assistants carried out the CAN version, adapted and translated into Portuguese by the investigators? group of the incidence study. Afterwards a blind investigator carried out the assessment independently, through tape-records of the interviews. Kappa coefficient and intraclass correlation coefficient were used to compare ratings of the independent investigator with ratings of the research assistants group. RESULTS: Fifty-two subjects were included, 27 (52%) of them were women. Most were in 18-39 age group, had studied eight years or less, and had diagnosis of schizophrenia or other schizophrenia spectrum disorders. Inter-rater reliability to 19 (87%) domains was substantial, almost perfect or total as measured by kappa coefficient. Reliability to total of needs measured by ICC was 0.95 (CI 95% 0,90 - 1,00). CONCLUSIONS: The Can showed good applicability and reliability with first contact psychotic individuals. The use of standardized instruments as the CAN in mental health services in Brazil, can contribute to the assessment of effectiveness of interventions, and individualized care to people with mental disorders.

No description available.

Evidence from various sources suggests that schizophrenia may result from altered brain development. The adult olfactory epithelium provides an available 'window' on neuronal development because new neurons are formed there throughout life. This thesis set out to test the neurodevelopmental hypothesis of psychotic disease. Two cell-based models, skin fibroblast and olfactory mucosa culture, were employed to investigate this hypothesis. In order to first demonstrate the utility of olfactory mucosa culture as a model of neurodevelopment, and to allow the candidate to gain proficiency in the culture of this tissue, an investigation of the mitogenic and differentiating properties of insulin-like growth factor-I within this system was undertaken. Insulin-like growth factor-I has multiple effects within the developing nervous system but its role in neurogenesis in the adult nervous system is less clear. The adult olfactory mucosa is a site of continuing neurogenesis that expresses insulin-like growth factor-I, its receptor, and its binding proteins. The action of insulin-like growth factor-I was assayed in several serum-free culture systems combined with bromodeoxyuridine labelling of proliferating cells and immunochemistry for specific cell types. Once proficiency in olfactory mucosa culture was gained, this model was applied to biopsied olfactory mucosa from schizophrenia and bipolar disorder patients in order to test the developmental parameters of adhesion, cell proliferation, and cell death in a neural tissue. It was previously shown that olfactory cultures from individuals with schizophrenia had increased cell proliferation and attached less frequently than cultures from healthy controls suggesting disrupted neurogenesis. An aim of this study was to replicate those observations in individuals with schizophrenia and and extend them to individuals with bipolar disorder. After completion of the cell and tissue culture assays, microarray analysis of these cell-based models was used to reveal gene expression differences present between patients and healthy controls. Microarray analysis is a complicated technique and the limited amounts of RNA that can be extracted from a single nasal biopsy further compounds this issue. In order to obtain enough material for microarray hybridization RNA samples underwent antisense amplification. Therefore, with the aim of allowing the candidate to gain proficiency in both these techniques prior to microarray analysis of olfactory biopsies from patients with schizophrenia and bipolar disorder, a pilot microarray study of cultured skin fibroblasts from schizophrenia patients and healthy controls was performed. The present findings show that insulin-like growth factor-I and its receptor were expressed by globose basal cells (the neuronal precursor), by neurons and by olfactory ensheathing cells, the special glia of the olfactory nerve. Insulin-like growth factor-I reduced the numbers of proliferating neuronal precursors, induced their differentiation into neurons, and promoted morphological differentiation of neurons. In contrast, this growth factor was mitogenic for olfactory ensheathing cells. The evidence suggests that insulin-like growth factor-I is an autocrine/paracrine signal that induces neuronal precursors to differentiate into olfactory sensory neurons and induces olfactory ensheathing cells to proliferate and that olfactory mucosa culture is valuable in modelling neurodevelopmental processes. When the olfactory musoca culture model was applied to patients with psychosis, a two-fold increase in proliferation of neural cells was found in schizophrenia compared to controls and bipolars. In bipolar cultures there was a 3-fold increase in cell death compared to controls and schizophrenia. Microarray analysis of cultured skin fibroblasts revealed differential expression of over 1000 genes between patients and controls. Inspection of the significant data showed alterations to gene expression between groups in the cell cycle, oxidative phosphorylation, TCA cycle and oxidative stress pathways. Gene expression in each of these pathways was predominately decreased in schizophrenia. Quantitative PCR analysis of selected differentially expressed genes involved with cell cycle regulation validated the increased expression of vitamin D receptor, and decreased expression of proliferating cell nuclear antigen and DEAD (Asp-GIu-Ala-Asp) box polypeptide 5 in skin fibroblasts from patients with schizophrenia. Microarray analysis of biopsied olfactory mucosa showed 146 and 139 differentially expressed genes in schizophrenia and bipolar disorder respectively, compared to controls. Consistent with increased mitosis in schizophrenia biopsy cultures three genes that function to positively influence cell cycle had increased expression. In the bipolar disorder group a dysregulation of the phosphatidylinositolsignalling pathway was seen; five genes that either directly function within or interact with this pathway had decreased expression. There is speculation that the therapeutic effect of psychotropic drugs acting upon this pathway in bipolar disorder involves reduction of neuronal cell death. Increased mitosis of neural cells has now been observed in two separate groups of schizophrenic patients indicating a robust finding. The use of fibroblast and olfactory mucosal tissue can be used to study biological and genetic aspects of neurodevelopment in living humans both with and without psychotic disease. Biopsied olfactory mucosa provides benefits over the use of autopsied material for study of psychotic disease because post-mortem duration and agonal factors that lead to tissue, protein and nucleic acid degradation are not an issue. This study provides evidence for a neurodevelopmental aetiology of schizophrenia and bipolar disorder acting at the level of cell cycle control. Subtle changes in the timing of cell cycle regulation could account for the brain pathologies observed in these diseases. Olfactory mucosa culture is a valuable model of neurodevelopmental processes.

Major psychotic disorders are one of the leading causes of disability worldwide, having severe impacts on the people who suffer from the conditions, their families and society. There is evidence that if these conditions are identified and treated early, the prognosis is improved. The purpose of this dissertation study is to produce two manuscripts related to the use of family aided community treatment (FACT) with individuals who are experiencing early psychotic disorders. Using a proof of concept design with multiple repeated-measure t tests, this study focused on first-episode psychotic disorder participants (n = 8), with an average age of 19.6 (sd = 3.28) and males comprising 75% of the sample engaged in a family aided community treatment (FACT) protocol in order to examine if psychiatric symptoms scale scores decreased post-intervention. The hypothesis which stated that a year-long family aided community treatment (FACT) intervention would reduce psychiatric symptoms when assessed by the Structured Interview for Prodromal Syndromes (SIPS), the Positive and Negative Symptoms Scale (PANSS), and the Global Functioning Scales in a first episode psychotic disorder sample, is supported. The FACT intervention decreased psychiatric symptom scores in this population. Implications of this study include improved training on early recognition for mental health clinicians and students, implementation of a specific treatment model in community settings, and policy around treatment funding allocation. / Graduation date: 2012

Bakgrund: Fysisk aktivitet har i studier kopplats till lindring av psykiska symtom som depression, oro, ångest samt en ökning av självupplevd livskvalitet. Vid insjuknande i psykossjukdom är det vanligt att drabbas av just ångest och depression. Dessa symtom i kombination med biverkningar från läkemedel ökar risken för en mindre hälsosam livsstil och fysisk inaktivitet, vilket kan leda till en ond cirkel och allt sämre fysisk och psykisk hälsa.Syfte: Syftet med föreliggande studie var att undersöka om det finns några skillnader mellan fysiskt hög- och lågaktiva personer med psykossjukdom avseende livskvalitet samt förekomst av depression och ångest. Syftet med studien var även att undersöka hur deltagarnas motionsvanor ser ut när det befinner sig på en sluten psykiatrisk vårdavdelning.Metod: Föreliggande studie är en kvantitativ tvärsnittsstudie. En enkät bestående av demografiska frågor, två skalor om fysisk aktivitet, en fråga om motionsform, en ångest- och depressionsskala samt en skala om livskvalitet, delades ut. I studien ingick 19 deltagare och svarsfrekvensen var 86 %. Data analyserades med det icke-parametriska testet Mann Whitney U-test. Signifikansnivån för samtliga statistiska test sattes till .05.Resultat: I analyser med skattningsskalan som mätte aktivitetsnivå överlag sågs signifikanta skillnader mellan låg- och högaktiva beträffande livskvalitet, ångest och depression (p=0.012, p=0.046, p=0.048). I analyser med skalan som mätte fysisk aktivitet de senaste två veckorna sågs inga signifikanta skillnader.Slutsatser: Personer med psykossjukdom som är högaktiva skattar sin livskvalitet högre än de som inte är det, och de skattar också lägre avseende förekomst av symtom på depression och ångest. / Background: Physical activity affects the hormonal system by alleviating psychological symptoms. There is support that physical activity also has effect on the self-perceived quality of life. Depression and anxiety are common among people with psychotic disorder, and combined with side effects from medication the risk of a less healthy lifestyle and inactivity increases.Aim: The aim of this study was to investigate whether there are any differences between those who are more and those who are less physically active when it comes to quality of life, depressive symptoms and anxiety symptoms among people with psychosis in a Swedish hospital. The aim was also to investigate what the patients’ exercise habits looked like while being admitted to the psychiatric inpatient care.Methods: This study is a quantitative cross-sectional survey performed in a psychiatric ward, specializing in psychosis. The study included 19 participants and the response rate was 86%. Data were analyzed using a non-parametric test, Mann Whitney U test. The significance levels for all statistical tests were set to .05.Results: On the scale measuring physical activity level in general there were significant differences between low-and high-level physically active participants regarding quality of life, anxiety and depression (p=0.012, p=0.046, p=0.048). On the scale, that measured the level of physical activity in the last two weeks, there were no significant differences.Conclusions: People with psychotic disorders that are high-level physically active, rate their quality of life higher and their symptom levels lower than those who score in the low-level regarding physical activity.

Background. The urban environment may increase the risk for psychotic disorder in interaction with pre-existing risk for psychosis, but direct confirmation has been lacking. The hypothesis was examined that the outcome of subclinical expression of psychosis during adolescence, as an indicator of psychosis-proneness, would be worse for those growing up in an urban environment, in terms of having a greater probability of psychosis persistence over a 3·5-year period. Method. A cohort of 918 adolescents from the Early Developmental Stages of Psychopathology Study (EDSP), aged 14–17 years (mean 15·1 years), growing up in contrasting urban and non-urban environments, completed a self-report measure of psychotic symptoms at baseline (Baseline Psychosis) and at first follow-up around 1 year post-baseline (T1). They were again interviewed by trained psychologists for the presence of psychotic symptoms at the second follow-up on average 3·5 years post-baseline (T2). Results. The rate of T2 psychotic symptoms was 14·2% in those exposed to neither Baseline Psychosis nor Urbanicity, 12·1% in those exposed to Urbanicity alone, 14·9% in those exposed to Baseline Psychosis alone and 29·0% in those exposed to both Baseline Psychosis and Urbanicity. The odds ratio (OR) for the combined exposure was 2·46 [95% confidence interval (CI) 1·46–4·14], significantly greater than that expected if Urbanicity and Baseline Psychosis acted independently. Conclusion. These findings support the suggestion that the outcome of the developmental expression of psychosis is worse in urban environments. The environment may impact on risk for psychotic disorder by causing an abnormal persistence of a developmentally common expression of psychotic experiences.

The purpose of this study was to describe experiences in daily social life of parents of children with psychotic illness. Five parents with long-term experience of psychotic illness have been interviewed. The frame of reference in emotion theories of Thomas Scheff and Randall Collins have been used to analyze the results. The study is qualitative and has a phenomenological approach to shed lights of meanings in daily social life. The following meanings was found: Openness with certain reservation shows that honesty is important for the feeling of solidarity, Social expectations in daily life describes the parents´own expectations as well as expectations from others. In The important confirmation the findings show that the parents´need understanding for the family situation, and the findings also show the importance of support for the family and the acceptance of the psychotic illness.