This project attempts to articulate an understanding of the worlds of selected subjects suffering from schizophrenia, through their dreams. It proceeds from the implicit question of whether or not schizophrenic dreams reflect the schizophrenic worlds as literature defines, and tries to address some of the dream features which reflect the schizophrenic world. Five psychiatric inpatients suffering from schizophrenia were selected. The data gathered included the subjects' dreams and subsequent interviews for the purpose of clarification of the dreams. A phenomenological-hermeneutic methodology was deemed to be appropriate as it gave access to the richness of the dream experiences as well as the following dialogue between the data and literature. The results indicate that the subjects' dream worlds bear evidence to a fragmented state of ego which is to be expected to be found in schizophrenia. On the other hand some of these subjects' dreams also point to evolving health that is present in their world, at least on an intrapsychic level.

This work addresses some of the difficulties encountered while working in psychotherapy with a residual schizophrenic. While there is an abundance of literature on psychotherapy for schizophrenia, both supporting and also refuting its merit, what the literature fails to reveal is that there appears to be a class of schizophrenic who, while apsychotic and able to communicate in the everyday sense of the word, is in a psychic space which speaks of a break with the basic relational elements of the human order. The quality of the patient's psychic life is such that almost nothing of what the literature describes as useful and appropriate in working with schizophrenics seems to help in the psychotherapeutic work with this type of patient. This study describes these issues with relevance to a particular residual schizophrenic. The Illustrative-didactic case-study method was used to discuss the four-and- a-half month psychotherapy with this patient. The patient's early developmental history, premorbid personality functioning, family and interpersonal relationships, mental state, diagnosis and a rationale for psychotherapy were presented and considered in detail. The structure of the psychotherapeutic process was reviewed in depth. The hermeneutic guidelines to understanding the case were drawn from Object-Relations Psychoanalytic theory, particularly Balint, Khan, Karon & VandenBos, Bollas, Romanyshyn, Perry, Symington, Fordham and others. Various psychic and personality features, as unveiled through the psychotherapeutic process, were elaborated and the implications of these for the therapeutic endeavour were considered as follows: Firstly, the psychic space of the patient, which precluded mirroring, symbolization find object-relationship - and which made psychotherapy untenable, was discussed. Secondly, therapeutic ambivalence and other counter-transference issues were reviewed. Thirdly, the shadow sides of both therapeutic optimism and of psychotherapeutic change were considered. Fourthly, the issues of therapeutic failure and of other treatment possibilities for a residual schizophrenic patient were examined. It was concluded that there needs to be an important countertransference shift with regard to the psychotherapeutic goals for those patients whose condition may be chronic, and for whom it appears that psychotherapy is not going to be of any therapeutic benefit - find where an 'empathic accompaniment' might be as much as it is possible to hope for or achieve.

Purpose: Family caregiving is vital to the health of persons with schizophrenia and without this support, many individuals would struggle to maintain their community tenure. While there is an abundance of literature that explores family caregiving in mental illness generally, less is known about the experiences of family caregivers of persons with schizophrenia. Furthermore, the primary caregiver for a person with schizophrenia tends to be a parent, and parent caregivers’ experiences differ from those of other types of family caregivers, such as spouses and children. Often, the experiences of parents’ caregiving for a person with schizophrenia are intermixed with the experiences of other types of family caregivers, which might minimize or distort their particular subjective realities. The purpose of this Thesis is to explore the experiences of parent caregivers of adult children with schizophrenia (ACWS) through a synthesis of existing literature and interviews with parent caregivers. Objectives: There were two objectives: 1) to review existing literature on the experiences of parent caregivers of adult children with schizophrenia and 2) to explore the experiences of parent caregivers of adult children with schizophrenia in a large urban Canadian city. Methods: This was a two-phase study using an emergent design. Phase one was an evidence synthesis of qualitative research on the experiences of parent caregivers of adult children with schizophrenia, modeled on the Joanna Briggs Methodology for qualitative systematic reviews. The review was conducted in accordance with the ENTREQ statement and all standard procedures were followed for citation screening, data extraction, and quality appraisal. Five Exploring the Experiences of Parent Caregivers in Schizophrenia iii studies were included from four countries (2009 – 2016). Phase two was an Interpretive Description qualitative study using interviews to explore parent experiences of caring for adult children with schizophrenia. Twelve parents (eight mothers and four fathers) completed interviews. In both phases of research, conventional content analysis was used to analyze data. Findings: Findings from the qualitative evidence synthesis revealed that parent caregivers of ACWS experience psychological distress, losses related to self and to child, and significant consequences for their families. Importantly, parent caregivers frame their experiences in positive and meaningful ways, which help them cope with their role. Parent caregivers included in the qualitative study described experiences of uncertainty and change related to their child’s schizophrenia and subsequently the actions they needed to take that were counter to their expected parent role. These parents further described the negative and positive effects of caregiving on their own lives. Finally, when comparing the findings of both phases of research, there were two cross-cutting considerations. First, parents have difficulty using and understanding the resources available in the mental health care system. Second, parents experience distress in their caregiver roles, and this distress is often induced or worsened as a result of barriers to treatment for their ACWS. Conclusion: Parent caregivers for persons with schizophrenia experience tremendous difficulty navigating the health care system. These challenges compound the psychological distress they already experience, by virtue of their role. Often, these parents prioritize their caregiving responsibilities above their own health and well-being. Health care providers must understand, acknowledge, and address parent caregivers’ needs, advocate for a less fragmented mental health care system, and support parent caregivers to be empowered and satisfied in their role.

No description available.

M.A. (Clinical Psychology) / Families, most commonly the adult daughters, provide the majority of informal caregiving. Research has focused on the negative implications of being a home caregiver to someone with an illness such as dementia, with very few studies considering the positive aspects that are associated with caregiving. This phenomenological study seeks to gain a deeper understanding into the holistic experience of Muslim women who are the primary home caregivers of a family member who has been diagnosed with dementia. Furthermore, this study contributes to the growing body of caregiving literature by considering the cultural context in which caregiving occurs. The sample is composed of three Muslim home caregivers of a family member living with dementia. Semi-structured interviews were used to obtain an in depth account of the participants’ experiences of caregiving. Data received for this study was analysed in accordance with Smith and Osborn’s (2008) steps for the method of interpretive phenomenological analysis. Themes that have emerged from the study include 1) understanding the condition; 2) reorganisation of life and the change of attitude towards caregiving; 3) social support; 4) strengthening the relationship with God and spiritual growth; 5) decision to care for the family member at home; and 6) anger and forgiveness. Through the interpretation of these themes, it was found that the caregivers’ cultural and religious values were deeply rooted and that the caregiving process can be transformed from a negative experience into a positive and meaningful experience provided that the caregiver changes their attitudes regarding their role and situation. Future research needs to be conducted to understand the various cultural contexts that influence the caregiving process.

The present study sought to examine the relationship between "Early Infantile Autism" and certain parental personality characteristics and family relationships reported in the literature as being associated with childhood schizophrenia. The three factors investigated were the *lack of empathy" and "emotional detachment", "the avoidance of Interpersonal interactions" and the dominance of the wife and submissiveness of the husband, each of which had been reported as characterizing the parents of schizophrenic children. Each of these characteristics was operationally defined and measured within the framework of the Interpersonal System of Personality Diagnosis. Using this method, it was possible to obtain measurements from four hypothesized levels of interpersonal functioning, consisting of how a person presents himself to or is described by others (Level I), his descriptions of himself and significant others (Level II), his fantasy or "projective" perceptions of people (Level III), and his ego ideal (Level V). The data of interpersonal behavior from each of these levels were scored in terms of a circular classificatory system made up of eight Interpersonal variables or ways of interacting (e.g. competitive - exploitive, skeptical - distrustful, cooperative - overconventional, etc). Trigonometric and arithmetic methods were then used to summarize interpersonal behavior at any level into a single point on a diagnostic grid incorporating the eight interpersonal variables. This was made possible by locating this single summary point In terms of a vertical (dominance - submission) and horizontal (hostility - affiliation) axis. As the summary points from each of the four levels were scored in terms of the same eight variables, it was possible to obtain objective measures of the discrepancies evident within or between the different hypothesized levels of functioning. Five hypotheses were formulated in the present study. Hypothesis 1 postulated that as viewed by others (Level I), the mothers would be the dominant members more often in the patient families than in the control families. Hypothesis 2 postulated that the patient parents would show greater disparity than the control parents between their self descriptions (Level II) and their descriptions by others (Level I). The third hypothesis postulated that the patient parents would misperceive the characteristics of their spouses to a greater degree than the control parents at Level II. The fourth hypothesis postulated that the patient parents would show greater disagreement in their descriptions of their child at Level II than the control parents. Hypothesis 5 postulated that the patient parents would, to a greater degree than the control parents, view people In Interpersonal interactions as being hostile and unaffiliative at the level of fantasy. Two groups of parents were utilized. The patient group consisted of six married couples, each having a child who had been accepted into a treatment program for schizophrenic children. Of the six children, five were diagnosed as autistic. The control group consisted of six married couples who had no children who had suffered from prolonged physical or emotional disturbances. Each couple was individually matched against one of the patient couples. Both groups were administered the MMPI, the Interpersonal Check List and the TAT. The results were then transformed into single summary point scores for the various levels of interpersonal functioning and the hypothesized relationships within and between levels tested. Of the five hypotheses formulated, only hypothesis 5 was found to differentiate the two groups at a .05 level of significance or better. The results showed that the patient parents tended to view people in interpersonal situations as being hostile and generally unloving. It was hypothesized that such attitudes might interfere with family functioning and have an adverse effect on relationships with the child. In conclusion, the current Investigation failed to find any widespread differences between a group of parents of autistic children and a group of parents of adequately functioning children. / Arts, Faculty of / Psychology, Department of / Graduate

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

Despite a prevailing paradigm that emphasizes an interaction of vulnerability and stress to account for the etiology of schizophrenia, diathesis—stress models of subsequent course and outcome of this disorder are rare. Even the simpler stress— process model, where the influence of stressors is mediated by supportive social relationships, has received little attention in studies of the course of schizophrenia. The objective of this study was to assess the following components of a diathesis—stress model as they predict the five-year outcome of first-episode schizophrenia: (1) stressful life events; (2) supportive social relationships; (3) brain lateral ventricle size; and (4) smooth pursuit eye movements. As part of the Greater Vancouver M.A.P. Project, we recruited first-episode DSM-III schizophrenia and affective psychosis patients. At intake to the study, their social relationships, smooth pursuit eye movement function, and brain ventricle size were assessed. Life events in the previous year were measured at intake; events over the following 18 months were assessed in two later interviews. Five years later we assessed outcome, using a global rating of social and occupational functioning. Descriptive results showed substantial variability within the schizophrenia group at intake and outcome. The trajectory of adaptive functioning over time was remarkably similar for the schizophrenic and affective psychosis groups. Of the four hypothesized predictors, only social relationships were associated (p=.O3) with five—year outcome. The number of life events was not associated with five—year outcome, nor was either of the biological risk factors. As a result, the predictor variables could not be combined in either a stress—process model or a vulnerability—stress model of the course of schizophrenia. That social relationship variables are associated with five-year outcome supports earlier findings regarding 18-month outcome, including the differing predictive roles for family and nonfamily relationships. The absence of hypothesized results for the life events data probably indicates that too much time had passed between outcome and the events as measured. Finally, that brain ventricle size and eye-movement dysfunction predict 18-month but not five—year outcome may indicate that impairment due to biological factors is expressed only in the early stages of schizophrenia. / Arts, Faculty of / Psychology, Department of / Graduate

Twenty-nine hospitalized patients suffering acute exacerbations of schizophrenia were treated for 2 weeks with fixed daily oral doses of haloperidol prospectively calculated to achieve a haloperidol plasma concentration of either 8-18 ng/ml or 25-35 ng/ml. Reduced haloperidol as well as haloperidol concentrations were assayed to determine if the former enhanced the predictability of response. Week 2 haloperidol plasma concentrations were negatively correlated to clinical response as measured by the percentage change in the BPRS score from baseline (r=-0.43, P<0.05). In contrast, week 2 plasma concentrations of reduced haloperidol, total haloperidol (haloperidol+reduced haloperidol), and reduced haloperidol/haloperidol ratio did not correlate with the change in the BPRS score. Chi-square analysis concluded that patients with ratios greater than one were no less likely to be treatment responders (<25% improvement in BPRS from baseline and week 2 BPRS <55) than those with ratios less than one. Although these data lend additional support to reports of a curvilinear relationship between haloperidol plasma concentration and clinical response, they also suggest that reduced haloperidol plasma concentrations are of no value in predicting treatment response.

No description available.