The relationships between lateral ventricle size, smooth pursuit eye tracking, and neuropsychological test performance were investigated using a sample of 30 chronic schizophrenic inpatients. There were no significant correlations between any of the measures. Compared to a control group of normal volunteers, the schizophrenic patients showed abnormally poor eye tracking accuracy but did not show lateral ventricular enlargement. Compared to a group of age matched non-schizophrenic psychiatric patients, the schizophrenic patients were impaired on six out of ten neuropsychological tests. As there was no evidence of lateral ventricle enlargement, it is clear that eye tracking impairment and deficits on neuropsychological tests may occur independently of enlarged lateral ventricles. The absence of relationships between impairments on the neuropsychological tests and poor eye tracking is not thought to be the result of restricted performance ranges for any of the measures. The most parsimonious conclusion is that there is no relationship between eye tracking and the variety of neuropsychological functions assessed in this study. However, an alternative possibility is that the study sample was too homogeneously impaired, and a relationship between eye tracking impairment and neuropsychological deficits might emerge in a more diverse sample representative of the range of individuals currently diagnosed as schizophrenic. / Arts, Faculty of / Psychology, Department of / Graduate

The current study aims to clarify how therapist competence/adherence relates to client characteristics, consumer satisfaction, and dropout rates for family interventions for schizophrenia. The study was conducted as part of a larger treatment trial which will test the efficacy of a culturally informed therapy for schizophrenia (CIT-S), against a treatment as usual (TAU) comparison group. Encouragingly, overall, therapists were found to demonstrate very high levels of competence/adherence in both treatment conditions. As hypothesized, less severe psychiatric symptoms and lower ratings of family difficulty were related to greater therapist competence/ adherence in several non-specific (e.g., establishing rapport) and CIT-S specific (fostering family cohesion) domains of treatment. Also as hypothesized, certain aspects of greater competence/ adherence were related to lower dropout rates and higher consumer satisfaction. Contrary to expectations, general emotional distress and family cohesion were not related to competence/adherence. This study suggests that clinicians and clinical researchers may want to take certain client characteristics into account when evaluating therapist performance, choosing clients who are most suitable for therapy, and providing feedback to supervisees. Additionally, clinicians and researchers may want to monitor therapist performance early on in treatment in order to address issues which may impact consumer satisfaction and treatment retention.

Schizoaffective disorder has routinely exhibited poor outcomes related to diagnostic accuracy and reliability. These pitfalls have been linked to the conceptual nature of Schizoaffective Disorder’s combined psychotic and affective symptoms. Clinicians likely perceive the psychotic components of Schizoaffective Disorder as more severe than the affective symptoms, and have demonstrated a bias toward misdiagnosing Schizoaffective Disorder as Schizophrenia. Thus, the present study sought to examine the clinical conceptualizations of Schizoaffective Disorder compared to Schizophrenia, Bipolar Disorder with psychotic features, and Major Depressive Disorder with psychotic features. The participants were clinicians recruited via email and randomly assigned to either select symptoms from a predetermined criteria list (Recognition group) or to freely list features of the disorders based on their own mental representations (Unprompted group). Participants’ conceptualizations of Schizoaffective Disorder were not entirely congruent with DSM-5 criteria; they conceptualized it as less psychotic than Schizophrenia and less affective than the two mood disorder tasks. Schizoaffective Disorder exhibited the lowest proportion of accurate endorsements, and Schizophrenia had the highest proportion. We hypothesized that Schizoaffective Disorder would have the most overextension endorsements because of its fuzzy boundaries, but Schizophrenia had the highest instead. The Recognition Group outperformed the Unprompted Group overall, which can be explained by the availability heuristic. This study’s findings support the notion that Schizoaffective Disorder’s poor diagnostic outcomes are possibly related to clinicians’ conceptualization of the construct, or that its current diagnostic formulation is not congruent with what clinicians observe in clinical settings.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2009. / Title from first page of PDF file (viewed August 11, 2009). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 36-39).

Thesis (Ph.D.)--Ohio University, June, 2009. / Title from PDF t.p. Includes bibliographical references.

No description available.

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.

The aim of the present thesis was to examine the effectiveness of the Illness Management and Recovery (IMR) program for teaching clients with schizophrenia or schizoaffective disorder to better manage their illness and to promote recovery. This was accomplished through an examination of the program’s effects on psychosocial functioning and psychopathology, the evaluation of general and specific impact of neurocognition on learning the fundamentals of illness self-management, and the impact of symptom severity on outcome of the IMR program. The utility of the illness management and recovery scale to evaluate illness self-management of clients with schizophrenia and schizoaffective disorder was also investigated. The effects of the IMR program were evaluated in a randomized controlled trial that compared participants in the program to participants receiving treatment as usual. 41 participants were recruited at six psychiatric outpatient rehabilitation centers in Uppsala, Sweden, and were randomly assigned to IMR groups for approximately 40 sessions or to a treatment as usual control condition. The IMR program participants demonstrated greater improvement compared to participants in treatment as usual in illness self-management, reduced psychiatric symptoms, improved coping skills, and decreases in suicidal ideation. The findings suggest that the IMR program is effective in improving the ability of individuals with schizophrenia and schizoaffective disorder to better manage their illness. Possible association between neurocognitive functioning and the acquisition of illness self-management skills was investigated in a total of 53 participants who completed the IMR program. Speed of processing was related to client reported illness self-management skills acquisition, before and after controlling for psychiatric symptoms and medication, but neurocognitive functioning did not predict improvement in clinician ratings of client illness self-management skills. The findings suggest that compromised neurocognitive functioning does not reduce response to training in illness self-management. The impact of symptom severity on outcome of the IMR program was explored in 52 participants who completed the program. The results suggest that significantly more participants met the severity criterion of remission at post-treatment, and it appears that participants not reaching the severity criterion at post-treatment, also benefited from the IMR program, as indicated by the similar effect sizes of the two subgroups (meeting versus not meeting the severity criterion at post-treatment). The psychometric properties of the Illness Management and Recovery Scale (IMRS) were evaluated in 107 participants with a diagnosis of schizophrenia or schizoaffective disorder. And an item-by-item investigation was conducted in order to establish their utility in monitoring the clients' progress in the IMR program. Both the client and clinician version of the IMRS demonstrated satisfactory internal consistency, large test-retest reliability, and convergent validity with conceptually related measures of psychiatric symptoms, quality of life, and perception of recovery. The findings support the utility of the IMRS as a measure of illness self-management and recovery in clients with schizophrenia and schizoaffective disorder. The general findings of this thesis support the IMR program to be effective in improving the ability of the participants to manage their disorder. The impact of neurocognitive dysfunction on the participants’ ability to learn the fundamentals of illness self-management seems to be limited, and symptom severity did not limit the benefits of the IMR program. Support for the utility of the IMRS to monitor the participants’ progress in the program was also found, providing a brief and economical method for assessing outcome of the IMR program. / Syftet med föreliggande avhandlingsarbete var att undersöka Illness Management and Recovery (IMR) programmets effekter av att lära klienter att bättre hantera negativa konsekvenser av schizofreni eller schizoaffektiv sjukdom och att främja återhämtning. Detta åstadkoms genom en utvärdering av IMR programmets inverkan på psykosocial funktion och psykopatologi, en undersökning av specifik och generell påverkan av neurokognition avseende deltagarnas möjligheter att lära in grundläggande sjukdomshanteringsfärdigheter (illness self-management), samt en undersökning av huruvida schizofrenisymtomens svårighetsgrad inverkar på programutfallet. Vidare undersöktes Illness Management and Recovery Skalans (IMRS) användbarhet för att utvärdera sjukdomshantering och återhämtning (illness self-management and recovery) hos personer med schizofreni eller schizoaffektiv sjukdom. IMR programmets effekter utvärderades genom en randomiserad kontrollerad studie i vilken 41 programdeltagare jämfördes med deltagare i kontrollgrupp vilka fick enbart sedvanlig psykiatrisk behandling. Deltagarna rekryterades vid sex subspecialiserade psykiatriska öppenvårdsmottagningar och slumpades till att antingen delta i IMR programmet eller kontrollgrupp. IMR programmets deltagare uppvisade i jämförelse med kontrollgruppen förbättring i sjukdomshantering, minskade psykiatriska symtom, förbättrade coping-färdigheter samt minskade självmordsbeteenden. Resultaten stöder antagandet att IMR programmet är effektivt vad gäller att förbättra deltagarnas förmåga att hantera negativa effekter av schizofreni och schizoaffektiv sjukdom. Möjliga associationer mellan neurokognitiv funktion och förmågan att tillägna sig färdigheter för sjukdomshantering undersöktes hos 53 deltagare som genomförde IMR programmet. Resultaten pekar på att neurokognitiva svårigheter inte inverkar på deltagarnas möjligheter att lära sig sjukdomshantering enligt IMR modellen. Processhastighet var relaterad till klientrapporterad sjukdomshantering men inte till klinikerrapporterad sjukdomshantering. Processhastighet tycks vara relevant för klientens upplevelse av hur väl han eller hon tillägnat sig programmets strategier och färdigheter, snarare än sjukdomshantering per se. Huruvida schizofrenisymtomens svårighetsgrad inverkar på utfallet av IMR programmet undersöktes hos 52 deltagare som genomförde IMR programmet. Resultaten pekar på att signifikant fler deltagare uppfyllde svårighetsgradskriteriet för remission av schizofrenisymtom efter genomfört IMR program. Även deltagare som inte uppfyllde svårighetsgradskriteriet har nytta av IMR programmet något som indikeras av de båda gruppernas (uppfyllde jämfört med uppfyllde inte svårighetsgradskriteriet) likartade effektstorlekar. Illness Management and Recovery Skalans (IMRS) psykometriska egenskaper undersöktes för 107 deltagare med en schizofreni eller schizoaffektiv diagnos. Skalans enskilda frågor analyserades för att undersöka skalans användbarhet för att utvärdera deltagares progress och utfall i IMR programmet. Både klient och kliniker versionen av skalan uppvisade tillfredsställande intern konsistens, stor test-retest reliabilitet och konvergent validitet med konceptuellt relaterade instrument för psykiatriska symtom, livskvalité och återhämtning. Resultaten stöder antagandet att IMRS är ett användbart instrument för att utvärdera sjukdomskontroll och återhämtning för personer med schizofreni eller schizoaffektiv sjukdom. Avhandlingsarbetets resultat stöder antagandet att IMR programmet är effektivt vad gäller att förbättra deltagarnas förmåga att hantera de negativa konsekvenserna av schizofreni och schizoaffektiv sjukdom. Neurokognitiva svårigheter inverkar i begränsad utsträckning på deltagarnas möjligheter att lära sig sjukdomshantering och schizofrenisymtom tycks ha begränsad inverkan på programutfallet. Resultaten stöder även antagandet att IMRS är ett användbart instrument för att utvärdera sjukdomskontroll och återhämtning för personer med schizofreni eller schizoaffektiv sjukdom, vilket erbjuder en kortfattad och ekonomisk metod att utvärdera effekterna av IMR.

No description available.

The issue of psychiatric co-morbidity is a serious public health problem occurring more and more frequently in the treatment of addiction and bringing with it various complications and often premature termination of treatment. The scoring system with a fixed set regime is still being used as the main instrument for treatment of addicted clients on the most specialized departments of psychiatric hospitals, although the effectiveness of the scoring system has not yet been clinically verified. The aim of this pilot study is to demonstrate and verify of the individual cases of clients with different categories of dual diagnosis, how they perceive the balance of the sanctions and rewards and fair setting in the context of the scoring system. Other goals are to find out and verify what is the influence of the scoring system on the motivation to change the behavior and success of treatment, what weaknesses clients with dual diagnosis perceive in this system and how they represent the treatment system, which would make them more fit and motivated to change behavior. Further, this study seeks to establish whether difficulties and obstacles on the way to stand up and go through the scoring system are different for individual dual diagnoses. A qualitative approach is used in the research part of the thesis....