Bakgrund: Det är sen tidigare känt hur återhämtning från psykisk ohälsa yttrar sig. Återhämtning och vägen dit anses vara högst individuell, om än med vissa gemensamma faktorer. Mindre omskrivet är återhämtning från psykossjukdom. Det är av värde att ytterligare litteraturstudier görs för att förtydliga och stärka eller identifiera nya gemensamma drag inom återhämtning vid psykossjukdom. Syfte: Sammanställa individers upplevelse av återhämtning vid psykossjukdom. Metod: En systematisk litteraturstudie bestående av 11 studier med kvalitativ ansats. Analysförfarandet genom metasyntes i enlighet med Howell Major och Savin-Baden. Resultat: Metasyntesen resulterade i tre tredje nivåns tema: Att individen förändras och utvecklas under återhämtningen, Att omgivningen bidrar till återhämtning och Att återhämtningsprocessen har hinder. Diskussion: Jämförelser med tidigare reviewstudiers resultat görs. Vissa skillnader återfinns, främst att återhämtning innebär att vara symtomfri. Likheter som framkommer är att återhämtning är en subjektivt upplevd process. Slutsats: Vetenskapligt stöd för litteraturstudiens resultat finns. Stark indikation för klinisk implikation då studiens resultat kan vara användbart för sjuksköterskor i motivationsarbete med patient. / Background: It is previously known what recovery from mental illness is. The recovery journey is a subjective process, even if some factors are recurrent. Less known is recovery from psychotic disorders. It is of great value that further systematic reviews cover the topic to clarify or strengthening already known results, or to find unknown facts about recovery from psychotic disorders. Aim: To compile the experiences of individuals recovering from psychotic disorders. Method: A systematic review including 11 studies with a qualitative approach, analyzed through meta-synthesis as described by Howell Major and Savin-Baden. Findings: The meta-synthesis resulted in three third-level themes: The individual changes and evolves during the recovery, The environment contributes to reco-very and The recovery process has obstacles. Discussion: Comparison with pre-vious reviews are made. Some differences are found, mainly that recovery means being symptom free. Similarities that emerge are that recovery is a subjectively experienced process. Conclusion: Scientific support for the systematic review is presented. Strong indication for clinical implication as the study's results may be useful for nurses in motivational work with a patient.

People with psychotic disorders die earlier than expected due to physical illnesses such as cardiovascular diseases, diabetes, and cancer. Despite substantial evidence about managing physical health to improve quality of life and reduce morbidity and mortality, there is limited research from the perspectives of people living with psychotic disorders. Since discourses are attached to all areas of knowledge, I situated myself within the critical social paradigm to understand factors that subjugate voices of people with psychotic disorders in research, practices, and policies. I used postcolonial theory as a lens for my research to show power asymmetry that often oppresses and dominates patients based on exclusion. Postcolonial theory in general and Spivak’s theory more specifically helped draw the parallel between systems of power such as colonization and patriarchy that silence the subaltern in the context of colonization and people with mental illness in psychiatry. Committing to Spivak’s theory of subalternity for self-representation, I chose digital storytelling as a methodological approach for generating transformative knowledge that exposes forces that mediate health and illness. Digital storytelling has an epistemological commitment to self-representation and critical reflection through visual, audio, and other forms of expression that facilitate more accurate articulations of experiences. The overarching purpose of this thesis was to explore the process of digital storytelling with people with psychotic disorders as a means of expressing their voices and to understand how nurses and healthcare leaders engage with the digital stories and foresee the use of digital stories in healthcare practices and policies. Six short videos capturing personal stories of people with psychotic disorders about their physical health needs and concerns were produced. Digital stories are audio-visual vignettes of approximately 2-5 minutes in length, presenting first-person stories in conjunction with audiovisual material (photos, images, soundtracks, etc.). The digital stories were presented in 2 focus group sessions to understand their impact on nurses and nursing leaders (n=15). Findings from this research brought forth stories that spoke of deep struggles people with psychotic disorders experience in addressing their physical health concerns within the psychiatric system. Participants talked about their embodied experiences and invisibility in the healthcare system in their digital stories. They expressed that healthcare providers had paternalistic approaches when addressing their physical health problems and revealed how they compensated for their lack of power and loss of identity. Story makers embedded their experiences with notions of powerlessness and despair and the associated negative impact on significant aspects of their lives. By reflecting on the digital stories and placing the content of stories within the larger context of the psychiatric system and current practices, nurses were able to expose power relations and structures such as quantitative approaches to care, stigma, and the biomedical model of care that excluded the experiences of people with psychotic disorders in psychiatry. Meanwhile, reflecting on the stories exposed nurses’ passive stance in challenging and resisting the dynamics that exclude patients’ voices at every level of care. In this research, Spivak’s theory helped highlight the thematic centrality of epistemic violence and the role of the digital stories in overcoming epistemic injustice and opening a line of communication with those in positions of power in psychiatry.

Recent studies have found associations between prolonged stress response and white matter (WM) microstructure in individuals with schizophrenia, as well as correlations between early life trauma and WM integrity in individuals with schizophrenia and non-psychiatric controls; however, psychosocial correlates of WM dysfunction have not yet been adequately explored in individuals experiencing attenuated psychotic symptoms (APS, subthreshold versions of positive psychotic symptoms). This study examines WM microstructure using traditional and free-water corrected diffusion metrics within a community sample of 66 16 to 30-year-olds experiencing a range of APS to examine the contribution of perceived stress and childhood trauma to the relationship between APS and WM abnormalities, as well as examine the moderating influence of sex assigned at birth (herein referred to as sex) to these relationships. We found that overall symptom severity on the Structured Interview for Psychosis-risk Syndromes (SIPS) was associated with higher extracellular free-water (FW) across the whole brain, lower free-water corrected fractional anisotropy values (FAT), and higher free-water corrected radial diffusivity (RDT). Further, childhood trauma significantly moderated the relationship between SIPS scores and both FAT and RDT, controlling for biological sex at birth, such that in the presence of APS, childhood trauma was associated with higher FAT and lower RDT, and in lower APS the opposite pattern was seen, with childhood trauma associated with lower FAT and lower RDT. After stratifying for sex, childhood trauma moderated the SIPS – FAT and RDT relationships in males similar to findings in the whole sample, though this relationship was not present in females. Perceived stress was not a significant moderator in the total sample, though was a significant moderator of the APS – FA relationship in males only. This study represents an important step toward identifying mechanisms for WM dysfunction within individuals with psychosis spectrum disorders, as well as identifying important targets for interventions. / Psychology

Schizotypy, a complex construct linked to schizophrenia-related traits, encompasses positive, negative, and disorganized symptoms. This study offers a review of the concept of schizotypy, including its historical evolution, tracing it from Bleuler's early mention in 1911 to Meehl's continuum model. Embracing a dimensional perspective, this research underscores the interplay of biological, psychological, and social factors in understanding schizotypy. Deficits in sustained attention and working memory within schizotypy remain underexplored, with prior studies yielding inconsistent results. Adaptive functioning deficits in individuals with schizotypy are also inadequately understood. Examining a college student population, this investigation utilized scores on the Schizotypal Personality Questionnaire – Brief Revised (SPQ-BR) to psychometrically define schizotypy, and it used the Community Assessment of Psychic Experiences (CAPE-42), World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), Continuous Performance Task (CPT-IP) and Visuospatial n-Back Task to assess the hypotheses. This was accomplished by comparing 60 individuals in the schizotypy group with 60 carefully matched controls. Contrary to expectations, those with schizotypy exhibited superior performance on sustained attention and visuospatial working memory tasks compared to controls, challenging the established literature, and warranting replication. The study addresses methodological gaps by using carefully matched control groups and employing innovative online cognitive tests. Despite observed cognitive strengths in performance, a paradox emerged as schizotypal individuals self-reported lower cognitive functioning, suggesting the need to focus on metacognition in schizotypy in future studies. This study underscores the need for a comprehensive systematic assessment of emerging young adult populations to understand their current psychological functioning relative to other community samples. The association between schizotypy, positive psychotic-like experiences, and increased self-reported disability suggests a need for the development of preventive interventions. The Hierarchical Taxonomy of Psychopathology (HITOP) is suggested as a promising assessment system for schizophrenia spectrum disorders in college students.

In this thesis, we developed prognostic models of clinical outcomes, specific to violent and criminal outcomes in psychiatry, and predictive models of treatment response at an individual level. Overall, we demonstrate that evidence-based risk factors, protective factors, and treatment status variables were able to prognosticate prospective physical aggression at an individual level; 2) prognostic models of clinical and violent outcomes in psychiatry have largely focused on clinical and sociodemographic variables, show similar performance between identifying true positives and true negatives, although the error rate of models are still high, and further refinement is needed; 3) within treatment response prediction models in MDD using EEG, greater performance was observed in predicting response to rTMS, relative to antidepressants, and across models, greater sensitivity (true positives), were observed relative to specificity (true negatives), suggesting that EEG prediction models thus far better identify non-responders than responders; and 4) across randomized clinical trials using data-driven biomarkers in predictive models, based on the consistency of performance across models with large sample sizes, the highest degree of evidence was in predicting response to sertraline and citalopram using fMRI features. / Dissertation / Doctor of Philosophy (PhD)

This research focuses on examining the neurological similarities between schizophrenia and major depressive disorder with psychotic features in order to compare the manifestations of psychosis in each disorder. Both disorders often involve symptoms of psychosis, although the overall disorders are very different from each other. The hypothesis for this research is that the neurological similarities between schizophrenia and major depressive disorder with psychotic features will provide researchers with the strategies needed to develop a treatment for psychotic symptoms. In order to test this hypothesis, five related studies were gathered for each disorder, and three studies were gathered for psychosis. These studies were then analyzed to pinpoint any similarities among factors for psychosis, and this analysis allowed for the determination of whether or not the hypothesis would be rejected. The results indicated that a lot of the similarities between the two disorders cannot be verified because of the lack of substantial research.

Psychosis has intrigued and confused neuroscientists for many years, yet there seems to be no clear explanation for why and how it occurs. There is also not just one disorder of psychosis, such as schizophrenia, some epileptic patients experience the same symptoms.That is called schizophrenia-like psychosis of epilepsy (SLPE), which is similar to primary schizophrenia but also very different. This systematic review will explain SLPE as a disorder in itself, compare it to other psychotic disorders, provide research findings and conclude what we can learn from better understanding psychosis in general.

Yes / Current NHS policy encourages an integrated approach to provision of mental and physical care for individuals with long term mental health problems. The 'PARTNERS2' complex intervention is designed to support individuals with psychosis in a primary care setting. The trial will evaluate the clinical and cost-effectiveness of the PARTNERS2 intervention. This is a cluster randomised controlled superiority trial comparing collaborative care (PARTNERS2) with usual care, with an internal pilot to assess feasibility. The setting will be primary care within four trial recruitment areas: Birmingham & Solihull, Cornwall, Plymouth, and Somerset. GP practices are randomised 1:1 to either (a) the PARTNERS2 intervention plus modified standard care ('intervention'); or (b) standard care only ('control'). PARTNERS2 is a flexible, general practice-based, person-centred, coaching-based intervention aimed at addressing mental health, physical health, and social care needs. Two hundred eligible individuals from 39 GP practices are taking part. They were recruited through identification from secondary and primary care databases. The primary hypothesis is quality of life (QOL). Secondary outcomes include: mental wellbeing, time use, recovery, and process of physical care. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action, and look for unintended consequences. An economic evaluation will estimate its cost-effectiveness. Intervention delivery and follow-up have been modified during the COVID-19 pandemic. The overarching aim is to establish the clinical and cost-effectiveness of the model for adults with a diagnosis of schizophrenia, bipolar, or other types of psychoses. / PARTNERS2 is funded by the National Institute for Health Research (NIHR) under its Programme Grant for Applied Research Programme (grant number: RP-PG- 200625). This research was also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust.

O presente estudo investigou a prevalência e a validade de construto das experiências psicóticas (EPs) na gestação e os fatores de risco associados em uma amostra comunitária do município de São Paulo. Foram investigados fatores de risco sociodemográficos, ambientais, transtornos psiquiátricos no presente e ao longo da vida, violência doméstica, capacidade intelectual e histórico familiar de transtornos psiquiátricos. Foram também avaliados desfechos da gestação e do parto. Trata-se de um estudo prospectivo, com início no 3º trimestre de gestação. As entrevistas de avaliação foram realizadas por psicólogos treinados. Para a avaliação das EPs, foi utilizado o instrumento de entrevista diagnóstica padronizada breve - Mini International Neuropsyquiatric Interview (M.I.N.I), validado para a realidade brasileira. Para os fatores de risco sociodemográficos, foram aplicados: questionário socioeconômico (QSE), densidade demográfica (DM) e utilizado o critério de classificação econômica do Brasil CCEB, pela Associação Brasileira de Empresas de Pesquisa (ABEP) e World Health Organization - WHO para violência doméstica. Foi realizada a avaliação da capacidade intelectual através da Escala de Inteligência Wechsler para adultos, terceira versão (WAISS-III) e investigado o histórico familiar para transtornos mentais através do The Family History Screen (FHS). Os resultados apontaram uma prevalência de 19,22% das EPs na gestação e compartilhando os fatores de risco presentes na esquizofrenia, como: urbanicidade, gestantes jovens, o uso de drogas e álcool, desvantagem socioeconômica, baixo nível de escolaridade, exposição à situações de violência, a presença dos transtornos psiquiátricos como depressão e ansiedade, e histórico familiar para qualquer condição psiquiátrica. Este estudo, realizado em uma região urbana da cidade de São Paulo, com altos índices de vulnerabilidade social, indica que a prevalência de EPs em gestantes é alta, afetando cerca de 1 em 6 mulheres. A presença de EPs associa-se fortemente com psicopatologia geral e com amplos fatores de risco. Neste sentido, a presença de EPs pode se constituir em um importante indicador de risco a ser avaliado em ambientes clínicos durante a gestação. Estudos futuros que possam investigar a sua utilidade para indicação de intervenções são necessários, assim como estudos que investiguem o curso de EPs apos o período gestacional e a sua associação com desfechos de saúde nas mulheres e em seus filhos / This research investigated the prevalence and construct validity of psychotic experiences (PEs) during pregnancy and the risk factors in a community sample in the city of São Paulo. Sociodemographic and environmental risk factors, psychiatric disorders, domestic violence, intellectual capacity and family history of psychiatric disorders in the present and throughout life were the investigated elements. Pregnancy and delivery outcomes were also evaluated. This is a prospective research, starting in the 3rd trimester of pregnancy. The evaluation interviews were conducted by trained psychologists. For the evaluation of PEs, the brief standardized diagnostic interview tool was used - Mini International Neuropsyquiatric Interview (M.I.N.I), validated for the Brazilian reality. For the sociodemographic risk factors, both socioeconomic questionnaire (SEQ) and population density (PD) were applied and the criterion of economic classification in Brazil (CECB) was used by the Brazilian Association of Research Companies (BARC) and World Health Organization - WHO for domestic violence. The intellectual capacity evaluation was carried out, using the Wechsler Intelligence Scale for Adults, third version (Waiss-III), and the family history of mental disorders was investigated through The Family History Screen (FHS). The results indicated a prevalence of 19.22% of PEs during pregnancy and sharing the risk factors present in schizophrenia, such as urbanicity, young pregnant women, use of drugs and alcohol, socioeconomically disadvantaged, low educational level, exposure to situations of violence, the presence of psychiatric disorders such as depression and anxiety, and family history of any psychiatric condition. This research, conducted in an urban area of the city of São Paulo, with high social vulnerability, indicates that the prevalence of PEs in pregnant women is high, affecting about 1 in 6 of them. The presence of PEs is strongly associated with general psychopathology and broad risk factors. In this sense, the presence of PEs may constitute an important risk factor to be evaluated in clinical environments during pregnancy. Future researches intending to look into its usefulness for indication of interventions are needed, as well as studies to search into the course of PEs after pregnancy and its association with health outcomes for women and their children

O presente estudo investigou a prevalência e a validade de construto das experiências psicóticas (EPs) na gestação e os fatores de risco associados em uma amostra comunitária do município de São Paulo. Foram investigados fatores de risco sociodemográficos, ambientais, transtornos psiquiátricos no presente e ao longo da vida, violência doméstica, capacidade intelectual e histórico familiar de transtornos psiquiátricos. Foram também avaliados desfechos da gestação e do parto. Trata-se de um estudo prospectivo, com início no 3º trimestre de gestação. As entrevistas de avaliação foram realizadas por psicólogos treinados. Para a avaliação das EPs, foi utilizado o instrumento de entrevista diagnóstica padronizada breve - Mini International Neuropsyquiatric Interview (M.I.N.I), validado para a realidade brasileira. Para os fatores de risco sociodemográficos, foram aplicados: questionário socioeconômico (QSE), densidade demográfica (DM) e utilizado o critério de classificação econômica do Brasil CCEB, pela Associação Brasileira de Empresas de Pesquisa (ABEP) e World Health Organization - WHO para violência doméstica. Foi realizada a avaliação da capacidade intelectual através da Escala de Inteligência Wechsler para adultos, terceira versão (WAISS-III) e investigado o histórico familiar para transtornos mentais através do The Family History Screen (FHS). Os resultados apontaram uma prevalência de 19,22% das EPs na gestação e compartilhando os fatores de risco presentes na esquizofrenia, como: urbanicidade, gestantes jovens, o uso de drogas e álcool, desvantagem socioeconômica, baixo nível de escolaridade, exposição à situações de violência, a presença dos transtornos psiquiátricos como depressão e ansiedade, e histórico familiar para qualquer condição psiquiátrica. Este estudo, realizado em uma região urbana da cidade de São Paulo, com altos índices de vulnerabilidade social, indica que a prevalência de EPs em gestantes é alta, afetando cerca de 1 em 6 mulheres. A presença de EPs associa-se fortemente com psicopatologia geral e com amplos fatores de risco. Neste sentido, a presença de EPs pode se constituir em um importante indicador de risco a ser avaliado em ambientes clínicos durante a gestação. Estudos futuros que possam investigar a sua utilidade para indicação de intervenções são necessários, assim como estudos que investiguem o curso de EPs apos o período gestacional e a sua associação com desfechos de saúde nas mulheres e em seus filhos / This research investigated the prevalence and construct validity of psychotic experiences (PEs) during pregnancy and the risk factors in a community sample in the city of São Paulo. Sociodemographic and environmental risk factors, psychiatric disorders, domestic violence, intellectual capacity and family history of psychiatric disorders in the present and throughout life were the investigated elements. Pregnancy and delivery outcomes were also evaluated. This is a prospective research, starting in the 3rd trimester of pregnancy. The evaluation interviews were conducted by trained psychologists. For the evaluation of PEs, the brief standardized diagnostic interview tool was used - Mini International Neuropsyquiatric Interview (M.I.N.I), validated for the Brazilian reality. For the sociodemographic risk factors, both socioeconomic questionnaire (SEQ) and population density (PD) were applied and the criterion of economic classification in Brazil (CECB) was used by the Brazilian Association of Research Companies (BARC) and World Health Organization - WHO for domestic violence. The intellectual capacity evaluation was carried out, using the Wechsler Intelligence Scale for Adults, third version (Waiss-III), and the family history of mental disorders was investigated through The Family History Screen (FHS). The results indicated a prevalence of 19.22% of PEs during pregnancy and sharing the risk factors present in schizophrenia, such as urbanicity, young pregnant women, use of drugs and alcohol, socioeconomically disadvantaged, low educational level, exposure to situations of violence, the presence of psychiatric disorders such as depression and anxiety, and family history of any psychiatric condition. This research, conducted in an urban area of the city of São Paulo, with high social vulnerability, indicates that the prevalence of PEs in pregnant women is high, affecting about 1 in 6 of them. The presence of PEs is strongly associated with general psychopathology and broad risk factors. In this sense, the presence of PEs may constitute an important risk factor to be evaluated in clinical environments during pregnancy. Future researches intending to look into its usefulness for indication of interventions are needed, as well as studies to search into the course of PEs after pregnancy and its association with health outcomes for women and their children