Journal articles on the topic 'Schizophrenia, substance, cognition, COMT'

IntroductionEarlier studies have shown that candidate gene risk polymorphisms and psychoactive substance abuse influence the frequency and severity of psychosis.ObjectivesIn this study we examined whether the most studied schizophrenia risk polymorphisms and psychoactive substance abuse interact in their influence on symptom severity and neurocognition.MethodsWe analyzed the clinical data of 280 schizophrenia patients, including genotyping data of the candidate genes NRG1, DTNBP1, RGS4, G72/G30 and PIP5K2A. Patients were assessed clinically by the Positive and Negative Symptom Scale (PANSS) and information about substance abuse was based on self-report and reviewing patient charts. We tested for possible interactional effects using the General Linear Model (GLM) analysis.Results15,8% of patients reported episodic or regular substance abuse, the vast majority (92%) used cannabis or the combination of cannabis and another drug. Substance abuse was associated with higher scores of the PANSS hostility/excitement factor, independent of sex, age, or genetic results (F = 4,02;p = 0,04). We found significant interactional effects of the DTNBP1 gene risk polymorphisms and substance abuse on different PANSS factors: rs2619528 and positive substance abuse interaction were associated with higher scores on the PANSS negative factor (F = 4,6;p = 0,03), and the PANSS depression factor (F = 4,75;p = 0,03). Moreover the rs3213207 - substance abuse interaction was associated with higher scores on the PANSS cognitive factor (F = 7,55;p = 0,006). Carriers of the Val allele of the COMT Val158Met polymorphism demonstrated significantly higher scores on the PANSS depression factor (F = 5,53;p = 0,02).ConclusionsOur results underscore the importance of gene-environment interactions in the phenotypic heterogeneity of schizophrenia.

AbstractBackground:Previous work suggests that reaction time variability (RTV) in attentional tasks, as a measure of cognitive stability, is associated with degree of Val loading in COMT Val158Met genotype, and that this association may be relevant for the aetiology of schizophrenia. This study examined (i) to what degree RTV pertaining to tasks of varying cognitive complexity would be associated with increased risk for schizophrenia and (ii) to what degree this would be mediated by Val loading.Methods:COMT genotyping was investigated in a sample of 23 patients with schizophrenia, 33 first-degree relatives, and 21 controls. All participants performed the Flanker continuous performance test.Results:Schizophrenia liability was associated with number of correct trials of the Flanker test, but not with RTV, and this association was not mediated by COMT Val158Met genotype. Similarly, Met loading was associated with number of correct trials and with RTV, but this was not mediated by schizophrenia liability.Conclusions:Associations between COMT Val158Met genotype and RTV do not appear to reflect transmission of schizophrenia liability in families. Differential associations with Val and Met alleles across studies suggest indirect effects through gene–gene interactions or the influence of a functional polymorphism near COMT Val158Met.

AbstractP300 wave anomalies correlate with genetic risk for schizophrenia and constitute a plausible endophenotype for the disease. The COMT gene is thought to influence cognitive performance and to be a susceptibility gene for schizophrenia. Unlike two previous studies, we found no significant influence of the COMT gene on P300 amplitude or latency in 189 individuals examined. The well-supported role of the COMT gene both in dopamine catabolism as well as in prefrontal cognition makes a strong theoretical case for the influence of COMT Val158Met polymorphism on P300 endophenotypes. However, the available neurophysiologic evidence suggests that any such association, if present, must be very subtle.

AbstractCatechol-O-methyl transferase (COMT) enzyme has a role in the inactivation of catecholamine neurotransmitters. Functional polymorphism in the COMT gene has been reported to play an important role in schizophrenia, bipolar affective disorder, aggressive and antisocial behavior, suicide attempts and the pathogenesis of Parkinson’s disease. In this study, we aimed to investigate the effect of the Vall58Met polymorphism of the COMT gene on substance use, and treatment history in patients with synthetic cannabinoid (SC) intoxication. The COMT enzyme Val158Met polymorphisms from DNA of 49 patients who were evaluated in the Emergency Department after SC use and 50 healthy control groups aged 18-45 years, were identified by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analyses as reported in the literature. Information regarding recurrent intake or hospitalization due to substance use was obtained from hospital records. Wild-type (WT) genotypes in 14 (28.6%) patients, heterozygous genotypes in 25 (51.0%) and homozygous genotypes in 10 (20.4%) patients were detected. Wild-type genotypes The homozygous genotype was found to be significantly higher in patients hospitalized due to drug addiction and substance use (p 0.008). The Vall58 Met polymorphism of the COMT gene was not found to be significant in the first use after substance intake, while a significant relationship was found in terms of this polymorphism in patients with substance addiction diagnosis and treatment history.

Schizophrenia, a severe psychiatric condition, is characterized by disturbances of cognition, emotion, and social functioning. The disease affects almost 1% of world population. Recent studies evaluating the role of catechol-O-methyltransferase enzyme (COMT) polymorphisms in the pathogenesis of schizophrenia have resulted in ambiguous findings. The current study examined the association of schizophrenia with three COMT polymorphisms, namely, rs737865, rs4680, and rs165599 in a Greek population. There was no significant association between schizophrenia and any of the three SNPs examined. However, haplotype analysis showed that cases have higher frequency of the T-A-A haplotype, and participants with that haplotype were at increased risk for developing schizophrenia (OR = 1.52; CL : 1.12–2.08; ). Furthermore, patients with schizophrenia displayed an excess of TC/AA/AA and the TT/AA/GA genotypes. Similarly a protective effect of TT/GG/GG and TT/GA/GG was suggested by our results.

BackgroundAuditory P50 sensory gating deficits correlate with genetic risk for schizophrenia and constitute a plausible endophenotype for the disease. The well-supported role of catechol-O-methyltransferase (COMT), brain-derived neurotrophic factor (BDNF) and neuregulin 1 (NRG1) genes in neurodevelopment and cognition make a strong theoretical case for their influence on the P50 endophenotype.MethodThe possible role of NRG1, COMT Val158Met and BDNF Val66Met gene polymorphisms on the P50 endophenotype was examined in a large sample consisting of psychotic patients, their unaffected relatives and unrelated healthy controls using linear regression analyses.ResultsAlthough P50 deficits were present in patients and their unaffected relatives, there was no evidence for an association between NRG1, COMT Val158Met or BDNF Val66Met genotypes and the P50 endophenotype.ConclusionsThe evidence from our large study suggests that any such association between P50 indices and NRG1, COMT Val158Met or BDNF Val66Met genotypes, if present, must be very subtle.

SummaryInformation-processing in the prefrontal cortex is abnormal in patients with schizophrenia. From functional neuroimaging and other studies, it appears that neurons of the dorsolateral prefrontal cortex are effectors of core clinical and biological phenomena associated with the illness. Cognitive deficits qualitatively similar to those in patients with schizophrenia are also found in their healthy siblings and other relatives. The evidence for abnormal prefrontal function in healthy siblings suggests that the deficit in information-processing is part of the biology of genetic susceptibility. Therefore, genetic variations in human DNA that affect this kind of information-processing may contribute part of the genetic risk for the illness. COMT is an enzyme that is distributed widely throughout the brain, but seems to be uniquely relevant to how dopamine affects information-processing in the prefrontal cortex. There is a common variation in the genetic sequence of the COMT gene, which causes a dramatic change in its enzyme activity. In people with schizophrenia, in their healthy siblings, and also in normal controls, the COMT genotype predicts 4% of the variation in human executive cognition and working memory. We have thus identified a genetic mechanism in the human species that affects the efficiency and efficacy of information-processing in the prefrontal cortex. It is, also, a weak genetic risk factor for schizophrenia: in family studies, it increases the risk of schizophrenia by 50-80%. Prefrontal neuronal tuning may be a target for new drug development in the future.

AbstractThe Val158Met polymorphism of the COMT gene is functional, easily detectable, and significantly related to metabolism of catecholamines, which underlie pathogenesis of a significant number of mental disorders. Evidence for the role of this polymorphism in schizophrenia, substance dependence, bipolar disorder, obsessive-compulsive disorder, anorexia nervosa and attention deficit hyperactivity disorder is summed up in this review article. The results make it unlikely that the COMT gene plays an important role in these mental disorders, although a minor effect can not be excluded. Future studies on the COMT gene in mentally ill subjects should be stratified by clinical subtypes of the disorder, gender and ethnicity. Studies of endophenotypes instead of the complex disorder seem to be another promising research strategy. Gene-gene and gene-environment interactions should also be considered. The COMT gene is probably not “a gene for” any mental disorder, but the Val158Met polymorphism appears to have pleiotropic effects on human behavior.

Abstract Background Schizophrenia spectrum disorders (SSD) are often characterised by a plateau or decline in cognitive abilities early in the prodrome. The cause of developmental alteration remains unknown, and investigation of genetic involvement in cognitive function in these disorders may assist the understanding of the underlying neurobiological mechanisms involved. Variation at two single nucleotide polymorphisms (SNPs) of the catechol-O-methyltransferase (COMT) gene have previously shown an influence on COMT protein levels and cognition; rs4680 and rs4818. Here we investigate the influence of the nonsynonymous “Val/Met” SNP rs4680 and a second functional SNP, rs4818, on tasks of cognitive flexibility and attention. Methods The sample comprised 48 healthy controls (HC; age = 31.95 ± 12.80; 25 males, 23 females), and 43 with a diagnosis of SSD (age = 41.64 ± 10.36; 26 males, 17 females). Measures of cognitive flexibility and attention included the Wisconsin Card Sorting Test (WCST), Continuous Performance Test-Identical Pairs version (CPT-IP), Trail Making Test (TMT), and the D-KEFS Colour Word Interference Test (CWIT). Due to small cohort sizes, in our preliminary analyses we chose to compare people who should be most severely affected because of inheriting COMT haplotypes associated with poor cognitive functioning (GG rs4818 / GG rs4680: G-G haplotype) to those with haplotypes associated with better cognitive functioning (CC rs4818 / AA rs4680: C-A haplotype). Multivariate analysis of variance factors included COMT haplotype, diagnosis (HC and SSD), and gender, with Bonferroni correction for multiple comparisons; age was included as a covariate. Analyses were also conducted based on a non-functional SNP of the COMT gene; rs165599, as a negative control. Results SSD exhibited reduced cognitive performance compared to HC; F(4, 75) = 8.810, p < .001. Investigation of C-A haplotype revealed an interaction with diagnosis on cognitive performance; F(8, 154) = 2.075, p = .041; SSD had reduced performance compared to HC for the WCST, CPT-IP, and TMT in C-A haplotypes (all p < .05). COMT haplotype also interacted with gender on cognitive performance (C-A haplotype; F(8, 154) = 2.315, p = .023, G-G haplotype; F(8, 154) = 2.706, p = .008). Males who were C-A non-carriers and /or G-G haplotype (high COMT activity groups) performed better on CPT-IP (both p < .05) and worse on CWIT (both p < .05) compared to females. Control SNP rs165599 revealed no main effects or significant interactions (all p > .05). Discussion The role of the COMT gene in the cognitive abilities of SSD remains contentious as gene expression does not differ from a healthy population. This preliminary analysis revealed an interaction between diagnosis and COMT haplotype, however, this only reached statistical significance for the C-A haplotype, where SSD with C-A haplotype and C-A non-carriers had reduced performance compared to HC on most tasks except TMT. The different effects found across the tasks, which probed various elements of cognitive flexibility and attention, supports a nuanced role of COMT in cognitive function. Further, high COMT activity was beneficial for males on CPT-IP but not CWIT compared to females. Gender interaction remains a significant consideration in studies of the COMT gene, likely involving the catechol-estrogens which are substrates of COMT. As expected there was no significant results with control SNP rs165599, indicating that findings were due to the influence of SNPs rs4680 and rs4818 on COMT activity.

BackgroundVelo-cardio-facial syndrome (VCFS) is associated with deletions at chromosome 22q11, abnormalities in brain anatomy and function, and schizophrenia-like psychosis. Thus it is assumed that one or more genes within the deleted region are crucial to brain development. However, relatively little is known about how genetic variation at 22q11 affects brain structure and function. One gene on 22q11 is catechol-O-methyltransferase (COMT): an enzyme that degrades dopamine and contains a functional polymorphism (Val158Met) affecting enzyme activity. Here, we investigated the effect of COMT Val158Met polymorphism on brain anatomy and cognition in adults with VCFS.MethodThe COMT Val158Met polymorphism was genotyped for 26 adults with VCFS on whom DNA was available. We explored its effects on regional brain volumes using hand tracing approaches; on regional grey- and white-matter density using computerized voxel-based analyses; and measures of attention, IQ, memory, executive and visuospatial function using a comprehensive neuropsychological test battery.ResultsAfter corrections for multiple comparisons Val-hemizygous subjects, compared with Met-hemizygotes, had a significantly larger volume of frontal lobes. Also, Val-hemizygotes had significantly increased grey matter density in cerebellum, brainstem, and parahippocampal gyrus, and decreased white matter density in the cerebellum. No significant effects of COMT genotype on neurocognitive performance were found.ConclusionsCOMT genotype effects on brain anatomy in VCFS are not limited to frontal regions but also involve other structures previously implicated in VCFS. This suggests variation in COMT activity is implicated in brain development in VCFS.

Research on the neuropsychology of substance use in schizophrenia has been steadily growing over the past decade. However, significant gaps remain in the knowledge of individual substances and their relationship to cognition in the schizophrenia spectrum disorders. Approximately 65 studies to date have directly examined this relationship. Of these, approximately 20 have focused on nicotine, 15 on alcohol, 10 on cocaine, three on stimulants/hallucinogens, one on benzodiazepines, 10 on polydrug abuse, and seven on cannabis. Research on cannabis is especially lacking, given that worldwide it is the most commonly used illicit drug in schizophrenia, is used at higher rates in schizophrenia than in the general population, and makes its own unique contribution to the onset and prognosis of schizophrenia. In the present paper an overview of the neuropsychology literature on substance use in schizophrenia is presented, with special emphasis on cannabis. This incorporates a discussion of the methodological limitations inherent in these studies, and range of potential confounding variables that were not considered or controlled, providing directions for future research into the cognitive correlates of cannabis and other substance use in schizophrenia.

BackgroundSubstance use may be a risk factor for the onset of schizophrenia.AimsTo examine the association between substance use and age at onset in a UK, inner-city sample of people with recent-onset schizophrenia.MethodThe study sample consisted of 152 people recruited to the West London First-Episode Schizophrenia Study. Self-reported data on drug and alcohol use, as well as information on age at onset of psychosis, were collected. Mental state, cognition (IQ, memory and executive function) and social function were also assessed.ResultsIn total, 60% of the participants were smokers, 27% reported a history of problems with alcohol use, 35% reported current substance use (not including alcohol), and 68% reported lifetime substance use (cannabis and psychostimulants were most commonly used). Cannabis use and gender had independent effects on age at onset of psychosis, after adjusting for alcohol misuse and use of other drugs.ConclusionsThe strong association between self-reported cannabis use and earlier onset of psychosis provides further evidence that schizophrenia may be precipitated by cannabis use and/or that the early onset of symptoms is a risk factor for cannabis use.

BackgroundPatients with schizophrenia suffer from cognitive deficits in seven domains in addition to social cognition. P300 latency and amplitude have been linked in these patients to the basic cognitive deficits.ObjectivesComparing patients suffering from schizophrenia with matched healthy subjects as regards auditory event related potential tests as measured by P300.Subjects and methodsFifty-two subjects were divided into 2 groups: group (A): 27 patients with schizophrenia according to the diagnostic and statistical manual of mental disorders-text revised (DSM-IV TR). Those with current substance use, psychiatric disorders or organic disorders were excluded. Group (B): 25 healthy control subjects with negative history of substance and psychiatric disorders. Patients were assessed using Positive and Negative Symptom Scale (PANSS) for severity of psychotic symptoms, Addenbrook's Cognitive Examination Revised (ACE-R) for basic cognitive, reading the mind in the eye test for social cognition, P300 and electro-encephalography (EEG)ResultsThe two groups were different significantly in ACE total and its subtests measuring attention-orientation, memory, language, visuospatial and reading the mind in the eye test for social cognition scores with patients showing lower scores (P = 0.000, 0.012, 0.000, 0.038, 0.041 and 0.001 respectively). Control group had higher amplitude of P300 and shorter latency than patients (P = 0.003 and 0.005 respectively). P300 amplitude correlated positively with visuospatial memory (P = 0.015). PANSS general pathology scale correlated positively with duration of untreated psychosis (P = 0.029) and with fluency (P = 0.047).ConclusionPatients with schizophrenia differ from controls in P300.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionInfluential protocols in the treatment of schizophrenia recommend the use of antipsychotics in monotherapy, although combination is common in clinical practice.Objectives/aimsTo compare cognitive performance of patients with schizophrenia treated by antipsychotic monotherapy or polytherapy; secondly, to analyze clinical and sociodemographic differences.MethodsNinety-eight outpatients between 18 and 65 years, diagnosed with schizophrenia, based on the DSM-V were recruited. Seventy were in monotherapy and 28 in antipsychotic combination. Patients with comorbidity, moderate to severe motor impregnation, abuse-substance dependence or serious somatic illness were excluded. Both groups were compared in sociodemographic, clinical and cognitive measures: PANSS scale, short Akathisia Scale Simpson-Angus Scale, State-Trait Anxiety Inventory (STAI), face emotion recognition (FEIT) and global Functioning (GAF), speed processing - through the Trail Making Test, parte A, subtest of symbol coding of the Brief Assessment of Cognition in Schizophrenia (BACS) and Verbal fluency (animals)- and sustained attention (SA)–through the Continuous Performance Test (CPT).ResultsBoth groups showed similar age, gender, number of hospitalizations, score in STAI-Trait, STAI-State, ANGUS, GAF, TMT-A, verbal fluency and face emotion recognition. Patients in politherapy had more years of evolution (P 0.047), higher score in positive PANSS (P 0.007), negative PANSS (P 0.008), general PANSS (P 0.001); they showed more detection errors in the CPT (P 0008), and a trend towards less processing speed through the symbol coding (P 0.063), compared to patients in monotherapy.ConclusionsAntipsychotic polipharmacy is associated with an impairment in sustained attention in patients with schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Aggressive and violent behavior, including both verbal and physical aggression, have considerable adverse consequences for people with schizophrenia. There are several potential causes of violent behavior on the part of people with severe mental illness, which include intellectual impairments, cognitive and social-cognitive deficits, skills deficits, substance abuse, antisocial features, and specific psychotic features. This review explores the interventions that have been tested to this date. Computerized Cognitive Training (CCT) or Computerized Social-Cognitive Training (CSCT) have been associated with reductions in violence. Combined CCT and CSCT have been found to improve social cognition and neurocognition, as well as everyday functioning when combined with rehabilitation interventions. These interventions have been shown to reduce violence in schizophrenia patients across multiple environments, including forensic settings. The reductions in violence and aggression have manifested in various ways, including reduced violent thinking and behavior, reduced physical and violent assaults, and reduced disruptive and aggressive behaviors. Effects of cognitive training may be associated with improvements in problem-solving and the increased ability to deploy alternative strategies. The effect of social cognition training on violence reduction appears to be direct, with improvements in violence related to the extent of improvement in social cognition. There are still remaining issues to be addressed in the use of CCT and CSCT, and the benefits should not be overstated; however, the results of these interventions are very promising.

ObjectiveThe objective of this systematic review was to investigate which specific and especially neurocognitive factors related to schizophrenia, were associated with homicide risk.MethodsA systematic English-French Medline literature search of cohort studies, case-control studies and transversal studies published from January 1999 to December 2009 was performed combining the MeSH terms “schizophrenia”, “homicide”, “violence”, “mental process”, “cognition”, “risk”, “risk factors”,. Abstract selection was based on the STROBE checklist for observational studies and on the consort statement for clinical trials.ResultsOf the 366 selected studies, 65 observational or prospective studies, 10 systematic reviews and meta-analysis and 2 interventional studies met the selection criteria and were included in the final analysis. Firstly, we highlighted that historical (past violence, juvenile detention, physical abuse, parental arrest record), dispositional (male gender, young age, low socioeconomic status) and contextual (recent divorce, unemployment, victimisation) factors could be considered as general homicide-related factors. Clinical factors (clinical paranoid, delusions of persecution or thought insertion, substance abuse, disorganized thinking, long duration of untreated psychosis, stopped monitoring or treatment) were more schizophrenia-specific factors for homicide. Most of the excess risk appears to be mediated by substance abuse. Secondly, our results suggested that schizophrenics with a history of aggressive behaviour compared to those without such history, had better performances on global neuropsychological tests exploring executive functions but performed more poorly as considering orbitofrontal functions.ConclusionsWe suggest that every comprehensive psychiatric assessment should explore the risk of homicide, including historical, dispositional, contextual, clinical and neurocognitive (low insight capacity, impaired frontal functions) factors of violence.

BackgroundSeveral national guidelines recommend continuous use of antipsychotic medication after a psychotic episode in order to minimize the risk of relapse. However some studies have identified a subgroup of patients who can obtain remission of psychotic symptoms while not being on antipsychotic medication for a long period of time. This study investigated the long-term outcome and characteristics of patients in remission of psychotic symptoms with no use of antipsychotic medication at the 10-year follow-up.MethodsThe study was a cohort study including 496 patients diagnosed with schizophrenia spectrum disorders (ICD 10: F20 and F22-29). Patients were included in the Danish OPUS Trial and followed up 10 years after inclusion, where patient data was collected on socio-demographic factors, psychopathology, level of functioning and medication.FindingsAmong the patients, 30% had remission of psychotic symptoms at the time of the 10-year follow up with no current use of antipsychotic medication. This favorable outcome was associated with female gender, high GAF-F score, participation in the labor market and absence of substance abuse.InterpretationResults from several RCTs advise against discontinuation of antipsychotic medication, but our results from the 10-year follow-up indicate that a subgroup do obtain long-term remission while not being on antipsychotic medication. Hence, guidelines on antipsychotic medication do not pay sufficient attention to patients who discontinue antipsychotic medication and are still able to obtain remission of psychotic symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract Background Cognitive impairment is a key feature of schizophrenia. While one recent study suggested that individuals with psychosis experience a progressive decline in certain cognitive domains during the first 10 years of their illness, other clinical and functional MRI-based studies have proposed that most cognitive deficits are present during the first episode and remain stable over time, possibly as a result of medication response. To examine the temporal nature of cognitive deficits in the schizophrenia spectrum, we examined cognition in never-medicated individuals at different stages of the illness. Methods We recruited three groups of patients: 1) individuals at clinical high-risk (CHR) for psychosis (n=87), 2) individuals experiencing their first-episode of a non-affective psychosis (FEP) (n=64) (defined by a duration of untreated psychosis < 74 weeks), and 3) individuals with chronic schizophrenia (n=40) (CSz – duration of untreated psychosis > 74 weeks). All three groups were antipsychotic-naïve. Patients with any comorbid disorders or current substance abuse disorders were excluded from this study. We also recruited matched healthy control subjects (n=102). All subjects were recruited at the Instituto Nacional de Neurología y Neurocirugía in Mexico City. The study was approved by the institutional review board. Adults provided written informed consent and minors provided assent with written consent provided by both parents. Cognition was assessed with the MATRICS Consensus Cognitive Battery. Differences between groups were analyzed using a repeated measures analysis of variance (RM-ANOVA) with cognitive domain as inter-subject factor and Bonferroni correction for post hoc pairwise comparisons. Statistical significance was set at p ≤ .05. Results Since age, gender, and parental education were significantly different between the groups, they were included as covariates in the RM-ANOVA. In this revised model, there was no main effect of age (p = 0.69) nor any interaction between age and any cognitive domain. Therefore, age was removed from the final model. We observed a significant main effect of group (p <.001); All patient groups were significantly impaired compared to the control group (CHR mean difference (MD) = 6.12; FEP MD = 16.46; CSz MD = 16.37; p <.001 in all cases), individuals with both FEP and CSz had significantly more cognitive impairment than the CHR group (FEP MD = 10.34; CSz MD = 10.25; p <.001 in both cases). No significant differences were observed between FEP and CSz groups (MD = .09, p >.99). We also found a significant group by cognitive domain interaction (p <.001). Namely, all patient groups were cognitively impaired compared to the control group, except in the Verbal and Visual Learning domains in which there were no significant differences between the control and CHR groups. No significant differences were found between the FEP and CSz groups in any domain. Moreover, the CHR group was not significantly different from the other clinical groups in the Social Cognition domain. Within the FEP and CSz groups, no significant correlations were observed between duration of untreated psychosis and any cognitive domain. Discussion We observed significant cognitive deficits since at-risk stages of the schizophrenia spectrum. Patients with FEP were as impaired as those with CSz, while cognitive functioning observed in CHR individuals was intermediate between controls and patients with syndromal psychosis. These results emphasize the importance of pre-syndromal detection and prediction of burgeoning psychotic illness. Future research on strategies to mitigate the decline in cognitive function between presyndromal and first-episode psychosis is warranted.

AbstractPurposeProgress in therapeutic options for schizophrenia has revived long-term expectations of researchers, practitioners and patients. At present, definitions of therapeutic outcome include both maintained symptomatic remission and appropriate functioning in a conceptual framework that targets patient's recovery as the ultimate goal. We aimed to know the prevalence and clinical features of patients with schizophrenia achieving these outcomes.MethodsA multi-centre, cross-sectional study was performed in more than 100 mental health facilities within Spain. Recently published consensus-based operational criteria for symptomatic remission and the Global Assessment of Functioning scale were used to evaluate outcomes. Other clinical aspects like depressive symptoms, social cognition, premorbid adjustment and patients' attitudes to medication were also evaluated.ResultsData from 1010 patients were analysed. Of these, 452 (44.8%) were at clinical remission, but only 103 (10.2%) showed an adequate social and/or vocational functioning. Factors predicting both outcomes were better pre-morbid adjustment (odds ratio, OR = 1.56) and better social cognitive function (OR = 1.14). Other factors, like treatment adherence, current or past psychotherapy and patient's age were not associated to functionality but only to clinical remission. Current substance use and previous rehabilitation were associated to a lower likelihood of symptomatic remission.ConclusionAlthough symptomatic remission in patients with schizophrenia is a realistic and reachable goal, future efforts should be directed to a sustained appropriate functioning in these patients.

Abstract Background Higher intestinal-permeability is known to cause low-grade chronic inflammation, which seems to participate in the development and worsening of psychotic disorders both in first-episode psychosis (FEP) and schizophrenia (SCZ) patients. Moreover, in psychotic disorders, inflammation has been linked to cognition and cognitive reserve (CR). The aim of this study is to assess the relation between intestinal-permeability, low-grade chronic inflammation, cognition and cognitive reserve in psychotic disorders. Methods Observational, cross-sectional and multisite study including four centers in Spain (Grant from Fondo de Investigación Sanitaria, PI17/00246). A total of 500 adult patients with DSM-5 SCZ-spectrum disorder at any stage of the disease were recruited. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Disease severity was assessed using the Clinical Global Impression (CGI) scale and functioning was assessed using the Global Assessment of Functioning (GAF) scale. The intestinal-permeability was estimated with the “Permeable-Intestine-syndrome questionnaire”. The diet was assessed with the “Mediterranean-diet-adherence questionnaire”. Exercise was measured with the “International Physical Activity Questionnaire (IPAQ)”. Cognition was measured with the SCIP-S scale. CR was assessed with the Cognitive Reserve Assessment Scale in Health (CRASH), which is a scale developed to measure CR specifically for patients with severe mental illness. Correlations between CRASH scores and the remainder variables were performed. Results For the present study we included only the subjects who had CRASH score, a total of 112 patients, 42.7% female, aged 40.61±12.4 (mean±SD). Substance use was present in 44.3%. The CRASH score was 33.30±15.72 (mean±SD) and was associated with negative (but not positive) psychotic symptoms assessed by PANSS (PANSS negative; rp=-3.98; p=0.001, PANSS general; rp=-2.13; p=0.038, GAF; rp=0.410; p<0.0001, CGI; rp=-0.30; p=0.002, IPAQ; rs=0.224; p=0.025 and the permeability-scale; rs=-0.266; p=0.008. All cognitive domains (assessed by SCIP-S) were associated to CRASH: verbal learning immediate (rp=0.584; p<0.0001) and differed (rp=0.515; p<0.0001), working memory (rp=0.539; p<0.0001), verbal fluency (rs=0.485; p<0.0001) and processing speed (rp=0.584; p<0.0001). No significant associations were found with Mediterranean-diet scale (rs=0.195; p=0.056), IMC (rs=-0.192; p=0.063), C-reactive protein (rs=-0.104; p=0.278) and the IPAQ-resting scale and permeability-scale (rs=0.119; p=0.244). Discussion

Background: While sex differences and gonadal hormone levels are taken seriously in the understanding and treatment of schizophrenia, their influence in the psychopathology of delusional disorders (DD) remains unknown. Methods: Our strategy was to conduct a narrative review of the effects of (a) sex/gender difference and (b) menopause on delusional content, affective and anxiety-related comorbidity, substance use disorders, cognition, aggressivity, and suicide risk in DD. Results: Because the literature is scarce, our results are tentative. We found that erotomania was more prevalent in women than in men, and especially in women with premenopausal onset. In contrast, jealous and somatic delusions were more commonly seen in DD women with postmenopausal onset. With respect to depressive comorbidity, women with premenopausal onset appear more vulnerable to depression than those with later onset. Age at menopause is reported to correlate positively with intensity of suicidal ideation. Anxiety symptoms may be related to estrogen levels. Men present with higher rates of substance use disorders, particularly alcohol use. Conclusions: Many male/female differences in DD may be attributable to sociocultural factors but menopause, and, therefore, levels of female hormones, influence symptom expression in women and mediate the expression of psychiatric comorbidities. Further research in this area promises to lead to improved individualized treatment.

Abstract Frailty, a clinical syndrome characterized by vulnerability to stressors resulting from a loss of physiological reserve across multiple systems, is a common condition that affects older adults. In patients with COVID 19 infection, frailty may place older adults at higher risk for poor clinical outcomes including hospitalizations. The aim of this study was to determine independent variables associated with all-cause hospitalization in Veterans with COVID 19 infection. This was a cross-sectional study nested within a retrospective cohort study of Veterans who contracted COVID 19 as detected by PCR. A VA Frailty Index (VA-FI) was generated at baseline as a proportion of morbidity, function, sensory loss, cognition and mood and other variables from electronic health records. The VA-FI categorized Veterans into non-frail (FI<.21) and frail (FI≥.21). At the time or after the COVID 19 testing, hospitalization data was aggregated, and proposed variables were subjected to stepwise backward logistic regression. Likelihood ratios were obtained, and those with p<0.05 were identified as independent risk factors for hospitalization. A total of 2621 Veterans with COVID 19 infection were identified during the study period with a total of 650 hospitalizations. Mean age was 54.99 (SD=16.71) years, 59.80% White, 87.60% male, 25.10% frail. The independent factors associated with hospitalization upon backward logistic regression were age (OR=1.049, 95%CI:1.041-1.057), frailty (OR=2.350, 95%CI: 1.797-3.074), African American race (OR=1.467, 95%CI:1.188-1.812), schizophrenia (OR=0.401, 95%CI:0.235-0.686), and substance abuse (OR=0.602, 95%CI:0.476-0.762). In veterans with COVID 19 infection, age, frailty, race (African American), schizophrenia, and substance abuse were predictors of all-cause hospitalization.

Introduction An extensive literature regarding gender differences relevant to several aspects of schizophrenia is nowadays available. It includes some robust findings as well as some inconsistencies. The identification of gender differences and the understanding of their explanations may help to clarify the underlying etiopathogenetic mechanisms of specific aspects of the disorder. Objectives The present study aimed at investigating gender differences on premorbid, clinical, cognitive and outcome indices, as well as their impact on recovery, in a large sample of patients with schizophrenia recruited within the multicenter study of the Italian Network for Research on Psychoses. Methods State-of-the-art instruments were used to assess the investigated domains. Group comparisons between male and female patients were performed on all considered indices. The associations of premorbid, clinical and cognitive indices with recovery in the two patient groups were investigated by means of multiple regressions. Results Males with respect to females had a worse premorbid adjustment – limited to the academic dimension – an earlier age of onset, a higher frequency of history of substance and alcohol abuse, more severe negative symptoms (both avolition and expressive deficit), positive symptoms and impairment of social cognition. No gender difference was observed in neurocognition nor in the rates of recovery. Conclusions Although males showed some disadvantages in the clinical picture, this was not translated into a worse outcome. This finding may be related to the complex interplay of several factors acting as predictors or mediators of outcome. Disclosure No significant relationships.

Executive functions, or cognitive control, are higher-order cognitive functions needed for adaptive goal-directed behaviours and are significantly impaired in majority of neuropsychiatric disorders. Different models and approaches are proposed for describing how executive functions are functionally organised in the brain. One popular and recently proposed organising principle of executive functions is the distinction between hot (i.e. reward or affective-related) versus cold (i.e. purely cognitive) domains of executive functions. The prefrontal cortex is traditionally linked to executive functions, but on the other hand, anterior and posterior cingulate cortices are hugely involved in executive functions as well. In this review, we first define executive functions, their domains, and the appropriate methods for studying them. Second, we discuss how hot and cold executive functions are linked to different areas of the prefrontal cortex. Next, we discuss the association of hot versus cold executive functions with the cingulate cortex, focusing on the anterior and posterior compartments. Finally, we propose a functional model for hot and cold executive function organisation in the brain with a specific focus on the fronto-cingular network. We also discuss clinical implications of hot versus cold cognition in major neuropsychiatric disorders (depression, schizophrenia, anxiety disorders, substance use disorder, attention-deficit hyperactivity disorder, and autism) and attempt to characterise their profile according to the functional dominance or manifest of hot–cold cognition. Our model proposes that the lateral prefrontal cortex along with the dorsal anterior cingulate cortex are more relevant for cold executive functions, while the medial–orbital prefrontal cortex along with the ventral anterior cingulate cortex, and the posterior cingulate cortex are more closely involved in hot executive functions. This functional distinction, however, is not absolute and depends on several factors including task features, context, and the extent to which the measured function relies on cognition and emotion or both.

Abstract Background Faster off-rate competitive enzyme inhibitors are generally more sensitive than slower off-rate ones to binding inhibition by enzyme substrates. We previously reported that the cyclic adenosine monophosphate concentration in dopamine D1 receptor-expressing medium spiny neurons (D1-MSNs) may be higher than that in D2-MSNs. Consequently, compared with slower off-rate phosphodiesterase 10A inhibitors, faster off-rate ones comparably activated D2-MSNs but partially activated D1-MSNs. We further investigated the pharmacological profiles of phosphodiesterase 10A inhibitors with different off-rates. Methods Phosphodiesterase 10A inhibitors with slower (T-609) and faster (T-773) off-rates were used. D1- and D2-MSN activation was assessed by substance P and enkephalin mRNA induction, respectively, in rodents. Antipsychotic-like effects were evaluated by MK-801- and methamphetamine-induced hyperactivity and prepulse inhibition in rodents. Cognition was assessed by novel object recognition task and radial arm maze in rats. Prefrontal cortex activation was evaluated by c-Fos immunohistochemistry in rats. Gene translations in D1- and D2-MSNs were evaluated by translating ribosome affinity purification and RNA sequencing in mice. Results Compared with T-609, T-773 comparably activated D2-MSNs but partially activated D1-MSNs. Haloperidol (a D2 antagonist) and T-773, but not T-609, produced antipsychotic-like effects in all paradigms. T-773, but not T-609 or haloperidol, activated the prefrontal cortex and improved cognition. Overall gene translation patterns in D2-MSNs by all drugs and those in D1-MSNs by T-773 and T-609 were qualitatively similar. Conclusions Differential pharmacological profiles among those drugs could be attributable to activation balance of D1- and D2-MSNs. The “balanced activation” of MSNs by faster off-rate phosphodiesterase 10A inhibitors may be favorable to treat schizophrenia.

Abstract Background The prevalence of schizophrenia in the United States ranges between 0.5% and 1%. This difficult-to-treat disorder is marked by the presentation of symptoms that are both positive (i.e. hallucinations) and negative (i.e. blunted affect), as well as disturbances in cognition and affect. Several second-generation antipsychotics (i.e. olanzapine, risperidone.) have been utilized for their varying effects on the symptoms of schizophrenia, yet 20% to 60% of patients with schizophrenia are considered treatment-resistant. While clozapine is shown to be the most effective antipsychotic, negative symptoms commonly persist in clozapine-treated patients. Research shows that oxytocin has neuromodulatory effects on social perception and enhances empathy and attentional engagement in individuals with schizophrenia, suggesting it may have therapeutic effects on negative symptoms. The present study presents a pilot prospective research study evaluating the efficacy of combining clozapine and sublingual oxytocin for the reduction of positive and negative symptoms. Methods Prospective research study evaluated 25 treatment resistant schizophrenic patients who were admitted to the persistent psychotic disorder unit at a private hospital, with an average treatment duration of 2.9 months with a range between 1 and 9 months. All have been followed as outpatient for up to 30 months after discharge. All patients were 18 years or older and met the DSM-5 criteria for schizophrenia. The Positive and Negative Syndrome Scale (PANSS) was used to assess the efficacy of the combination treatment. Clozapine was prescribed to all 25 patients after they had failed to improve in three different trials of other antipsychotic medications. Sublingual oxytocin (10 IU 2x per day; 20 IU 3x per day) was prescribed to 25 of the patients only after the improvement in positive symptoms on the PANSS with clozapine had plateaued. Due to a history of intranasal substance use in all the patients, oxytocin was administered sublingual to ensure adequate and less variable absorption of the neuropeptide. Results A time-series analysis demonstrated a significant decrease in PANSS scores across admission, stabilization of clozapine and stabilization of oxytocin (p <.02) with the overall average PANSS score on admission was 102; after stabilization on clozapine, the average score decreased to 68. After administration oxytocin (8 weeks) the average score decreased further to 47 and improved PANSS score were not related to serum clozapine levels. Clinical and family notes indicated clinically meaningful improvements in affect, eye contact, and ability to socialize. These gains have been sustained over the full range of our observations. Families self-reported an increased ability to participate in social roles and activities. Discussion The combined effect extends the current research of augmenting sublingual oxytocin and clozapine for individuals with previously treatment-resistant symptoms. Though each patient benefitted from clozapine alone, negative symptoms persisted. Patients, their families, and treatment program staff all observed a significant reduction in the patients’ anxiety and an improvement in the patients’ relatedness. While this case series cannot establish that oxytocin is responsible for the clinical improvements seen here, it does suggest that it may improve negative symptoms and social functioning in patients with treatment-resistant schizophrenia showing incomplete improvement with clozapine alone. The present study suggests the need for future research to explore the possibility that oxytocin can mitigate the negative symptoms of schizophrenia.

<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Bipolar disorder not otherwise specified -overdiagnosed or underdiagnosed?</strong></p><p>E Allers</p><p><strong>2. The prognosis of major depression untreated and treated: Does the data reflect the true picture of the prognosis of this very common disorder?</strong></p><p>E Allers</p><p><strong>3. Can we prolong our patients' life expectancy? Providing a better quality of life for patients with severe mental illness</strong></p><p>O A Betencourt</p><p><strong>4. The scope of ECT practice in South Africa</strong></p><p>J Benson-Martin, P Milligan</p><p><strong>5. Biomarkers for schizophrenia: Can we evolve like cancer therapeutics?</strong></p><p>P Buckley<strong></strong></p><p><strong>6. Relapse in schizophrenis: Major challenges in prediction and prevention</strong></p><p>P Buckley</p><p><strong>7. Informed consent in biological treatments: The right to know the duty to inform</strong></p><p><strong></strong>I Chetty</p><p><strong>8. Effectiveness of a long-acting injectable antipsychotic plus an assertive monitoring programme in first-episode schizophrenia</strong></p><p><strong></strong>B Chiliza, L Asmal, O Esan, A Ojagbemi, O Gureje, R Emsley</p><p><strong>9. Name, shame, fame</strong></p><p>P Cilliers</p><p><strong>10. Can we manage the increasing incidence of violent raging children? We have to!</strong></p><p>H Clark</p><p><strong>11. Serotonin, depression and antidepressant action</strong></p><p>P Cowen</p><p><strong>12. Prevalence and correlates of comorbid psychiatris illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit</strong></p><p>L Dannatt, K J Cloete, M Kidd, L Weich</p><p><strong>13. Investigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers</strong></p><p>A K Domingo, S Seedat, T M Esterhuizen, C Laurence, J Volmink, L Asmal</p><p><strong>14. Neuropeptide S -emerging evidence for a role in anxiety</strong></p><p>K Domschke</p><p><strong>15. Pathogenetics of anxiety</strong></p><p>K Domschke</p><p><strong>16. The effects of HIV on the fronto-striatal system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>17. Effects of acute antipsychotic treatment on brain morphology in schizophrenia</strong></p><p>R Emsley, L Asmal, B Chiliza, S du Plessis, J Carr, A Goosen, M Kidd, M Vink, R Kahn</p><p><strong>18. Development of a genetic database resource for monitoring of breast cancer patients at risk of physical and psychological complications</strong></p><p>K Grant, F J Cronje, K Botha, J P Apffelstaedt, M J Kotze</p><p><strong>19. Unipolar mania reconsidered: Evidence from a South African study</strong></p><p><strong></strong>C Grobler</p><p><strong>20. Antipsychotic-induced movement disorders: Occurence and management</strong></p><p>P Haddad</p><p><strong>21. The place of observational studies in assessing the effectiveness of long-acting injectable antipsychotics</strong></p><p>P Haddad</p><p><strong>22. Molecular mechanisms of d-cycloserine in fear extinction: Insights from RNS sequencing</strong></p><p>S Hemmings, S Malan-Muller, L Fairbairn, M Jalali, E J Oakeley, J Gamieldien, M Kidd, S Seedat</p><p><strong>23. Schizophrenia: The role of inflammation</strong></p><p>DC Henderson</p><p><strong>24. Addictions: Emergent trends and innovations</strong></p><p>V Hitzeroth</p><p><strong>25. The socio-cultural-religious context of biological psychiatric practice</strong></p><p>B Janse van Rensburg</p><p><strong>26. Biochemical markers for identifying risk factors for disability progression in multiple sclerosis</strong></p><p><strong></strong>S Janse van Rensburg, M J Kotze, F J Cronje, W Davis, K Moremi, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>27. Alcohol-induced psychotic disorder: Brain perfusion and psychopathology - before and after antipsychotic treatment</strong></p><p>G Jordaan, J M Warwick, D G Nel, R Hewlett, R Emsley</p><p><strong>28.'Pump and dump': Harm reduction strategies for breastfeeding while using substances</strong></p><p>L Kramer</p><p><strong>29. Adolescent neuropsychiatry - an emerging field in South African adolescent psychiatric services</strong></p><p>A Lachman</p><p><strong>30. Recovery versus remission, or what it means to be healthy for a psychiatric patient?</strong></p><p>B Latecki</p><p><strong>31. Holistic methods utilised to normalise behaviours in youth diagnosed with neuro-biochemical disorders</strong></p><p>P Macqueen</p><p><strong>32. Candidate genes and novel polymorphisms for anxiety disorder in a South African cohort</strong></p><p>N McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D Stein, V Russel, C Lochner</p><p><strong>33. Higher visual functioning</strong></p><p>A Moodley</p><p><strong>34. The effects of prenatal methylmercury exposure on trace element and antioxidant levels in rat offspring following 6-hydroxydopamine-induced neuronal insult</strong></p><p>Z M Moosa, W M U Daniels, M V Mabandla</p><p><strong>35. Paediatric neuropsychiatric movement disorders</strong></p><p>L Mubaiwa</p><p><strong>36. The South African national female offenders study</strong></p><p>M Nagdee, L Artz, C de Clercq, P de Wet, H Erlacher, S Kaliski, C Kotze, L Kowalski, J Naidoo, S Naidoo, J Pretorius, M Roffey, F Sokudela, U Subramaney</p><p><strong>37. Neurobiological consequences of child abuse</strong></p><p>C Nemeroff</p><p><strong>38. What do Stellenbosch Unviversity medical students think about psychiatry - and why should we care?</strong></p><p>G Nortje, S Suliman, K Seed, G Lydall, S Seedat</p><p><strong>39. Neurological soft skins in Nigerian Africans with first episode schizophrenia: Factor structure and clinical correlates</strong></p><p><strong></strong>A Ojagbemi, O Esan, O Gureje, R Emsley</p><p><strong>40. Should psychiatric patients know their MTHFR status?</strong></p><p>E Peter</p><p><strong>41. Clinical and functional outcome of treatment refractory first-episode schizophrenia</strong></p><p>L Phahladira, R Emsley, L Asmal, B Chiliza</p><p><strong>42. Bioethics by case discussion</strong></p><p>W Pienaar</p><p><strong>43. Reviewing our social contract pertaining to psychiatric research in children, research in developing countries and distributive justice in pharmacy</strong></p><p>W Pienaar</p><p><strong>44. The performance of the MMSE in a heterogenous elderly South African population</strong></p><p>S Ramlall, J Chipps, A I Bhigjee, B J Pillay</p><p><strong>45. Biological basis addiction (alocohol and drug addiction)</strong></p><p>S Rataemane</p><p><strong>46. Volumetric brain changes in prenatal methamphetamine-exposed children compared with healthy unexposed controls</strong></p><p><strong></strong>A Roos, K Donald, G Jones, D J Stein</p><p><strong>47. Single voxel proton magnetic resonance spectroscopy of the amygdala in social anxiety disorder in the context of early developmental trauma</strong></p><p>D Rosenstein, A Hess, S Seedat, E Meintjies</p><p><strong>48. Discussion of HDAC inhibitors, with specific reference to supliride and its use during breastfeeding</strong></p><p>J Roux</p><p><strong>49. Prevalence and clinical correlates of police contact prior to a first diagnosis of schizophrenia</strong></p><p>C Schumann, L Asmal, K Cloete, B Chiliza, R Emsley</p><p><strong>50. Are dreams meaningless?</strong></p><p>M Solms</p><p><strong>51. The conscious id</strong></p><p>M Solms<strong></strong></p><p><strong>52. Depression and resilience in HIV-infected women with early life stress: Does trauma play a mediating role?</strong></p><p>G Spies, S Seedat</p><p><strong>53. State of affairs analysis for forensic psychiatry in SA</strong></p><p>U Subramaney</p><p><strong>54. Escitalopram in the prevention of post-traumatic stress disorder: A pilot randomised controlled trial</strong></p><p>S Suliman, S Seedat, J Pingo, T Sutherland, J Zohar, D J Stein</p><p><strong>55. Epigenetic consequences of adverse early social experiences in primates</strong></p><p>S Suomi</p><p><strong>56. Risk, resilience, and gene x environment interactions in primates</strong></p><p>S Suomi</p><p><strong>57. Biological aspects of anorexia nervosa</strong></p><p>C Szabo</p><p><strong>58. Agents used and profiles of non-fatal suicidal behaviour in East London</strong></p><p>H Uys</p><p><strong>59. The contributions of G-protein coupled receptor signalling to opioid dependence</strong></p><p>J van Tonder</p><p><strong>60. Emerging trend and innovation in PTSD and OCD</strong></p><p>J Zohar</p><p><strong>61. Making the SASOP treatment guidelines operational</strong></p><p>E Allers</p><p><strong>Poster Presentations</strong></p><p><strong>62. Neuropsychological deficits in social anxiety disorder in the context of early developmental trauma</strong></p><p><strong></strong>S Bakelaar, D Rosenstein, S Seedat</p><p><strong>63.Social anxiety disorder in patients with or without early childhood trauma: Relationship to behavioral inhibition and activation and quality of life</strong></p><p><strong></strong>S Bakelaar, C Bruijnen, A Sambeth, S Seedat</p><p><strong>64. Exploring altered affective processing in obssessive compulsive disorder symptom subtypes</strong></p><p>E Breet, J Ipser, D Stein, C Lochner<strong><br /></strong></p><p><strong>65. To investigate the bias toward recognising the facial expression of disgust in obsessive compulsive disorder as well as the effect of escitalopram</strong></p><p>E Breet, J Ipser, D Stein, C Lochner</p><p><strong>66. A fatal-case of nevirapine-induced Stevens-Johnson's syndrome in HIV mania</strong></p><p>A Bronkhorst, Z Zingela, W M Qwesha, B P Magigaba<strong></strong></p><p><strong>67. Association of the COMT G472A (met/met) genotype with lower disability in people diagnosed with multiple sclerosis</strong></p><p>W Davis, S J van Rensburg, L Fisher, F J Cronje, D Geiger, M J Kotze</p><p><strong>68. Homocycsteine levels are associated with the fat mass and obesity associated gene FTO(intron 1 T&gt;A) polymorphism in MS patients</strong></p><p>W Davis, S J Van Rensburg, M J Kotze, L Fisher, M Jalali, F J Cronje, K Moremi, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>69. Analysis of the COMT 472 G&gt;A (rs4680) polymorphism in relation to environmental influences as contributing factors in patients with schizophrenia</strong></p><p>D de Klerk, S J van Rensburg, R A Emsley, D Geiger, M Rensburg, R T Erasmus, M J Kotze</p><p><strong>70. Dietary folate intake, homocysteine levels and MTHFR mutation detection in South African patients with depression: Test development for clinical application </strong></p><p>D Delport, N vand der Merwe, R Schoeman, M J Kotze</p><p><strong>71. The use ofexome sequencing for antipsychotic pharmacogenomic applications in South African schizophrenia patients</strong></p><p>B Drogmoller, D Niehaus, G Wright, B Chiliza, L Asmal, R Emsley, L Warnich</p><p><strong>72. The effects of HIV on the ventral-striatal reward system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>73. Xenomelia relates to asymmetrical insular activity: A case study of fMRI</strong></p><p>S du Plessis, M Vink, L Asmal</p><p><strong>74. Maternal mental helath: A prospective naturalistic study of the outcome of pregancy in women with major psychiatric disorders in an African country</strong></p><p>E du Toit, L Koen, D Niehaus, B Vythilingum, E Jordaan, J Leppanen</p><p><strong>75. Prefrontal cortical thinning and subcortical volume decrease in HIV-positive children with encephalopathy</strong></p><p>J P Fouche, B Spottiswoode, K Donald, D Stein, J Hoare</p><p><strong>76. H-magnetic resonance spectroscopy metabolites in schizophrenia</strong></p><p>F Howells, J Hsieh, H Temmingh, D J Stein</p><p><strong>77. Hypothesis for the development of persistent methamphetamine-induced psychosis</strong></p><p><strong></strong> J Hsieh, D J Stein, F M Howells</p><p><strong>78. Culture, religion, spirituality and psychiatric practice: The SASOP Spirituality and Psychiatry Special Interest Group Action Plan for 2012-2014</strong></p><p>B Janse van Rensburg</p><p><strong>79. Cocaine reduces the efficiency of dopamine uptake in a rodent model of attention-deficit/hyperactivity disorder: An <em>in vivo</em> electrochemical study</strong></p><p><strong></strong>L Kellaway, J S Womersley, D J Stein, G A Gerhardt, V A Russell</p><p><strong>80. Kleine-Levin syndrome: Case in an adolescent psychiatric unit</strong></p><p>A Lachman</p><p><strong>81. Increased inflammatory stress specific clinical, lifestyle and therapeutic variables in patients receiving treatment for stress, anxiety or depressive symptoms</strong></p><p>H Luckhoff, M Kotze, S Janse van Rensburg, D Geiger</p><p><strong>82. Catatonia: An eight-case series report</strong></p><p>M Mabenge, Z Zingela, S van Wyk</p><p><strong>83. Relationship between anxiety sensitivity and childhood trauma in a random sample of adolescents from secondary schools in Cape Town</strong></p><p>L Martin, M Viljoen, S Seedat</p><p><strong>84. 'Making ethics real'. An overview of an ethics course presented by Fraser Health Ethics Services, BC, Canada</strong></p><p>JJ McCallaghan</p><p><strong>85. Clozapine discontinuation rates in a public healthcare setting</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>86. Retrospective review of clozapine monitoring in a publica sector psychiatric hospital and associated clinics</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>87. Association of an iron-related TMPRSS6 genetic variant c.2007 C&gt;7 (rs855791) with functional iron deficiency and its effect on multiple sclerosis risk in the South African population</strong></p><p>K Moremi, S J van Rensburg, L R Fisher, W Davis, F J Cronje, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus, M Kidd, M J Kotze</p><p><strong>88. Identifying molecular mechanisms of apormophine-induced addictive behaviours</strong></p><p>Z Ndlazi, W Daniels, M Mabandla</p><p><strong>89. Effects of lifestyle factors and biochemistry on the major neck blood vessels in patients with mutiple sclerosis</strong></p><p>M Nelson, S J van Rensburg, M J Kotze, F Isaacs, S Hassan</p><p><strong>90. Nicotine protects against dopamine neurodegenration and improves motor deficits in a Parkinsonian rat model</strong></p><p>N Ngema, P Ngema, M Mabandla, W Daniels</p><p><strong>91. Cognition: Probing anatomical substrates</strong></p><p>H Nowbath</p><p><strong>92. Chronic exposure to light reverses the effects of maternal separation on the rat prefrontal cortex</strong></p><p>V Russel, J Dimatelis</p><p><strong>93. Evaluating a new drug to combat Alzheimer's disease</strong></p><p>S Sibiya, W M U Daniels, M V Mabandla</p><p><strong>94. Structural brain changes in HIV-infected women with and without childhood trauma</strong></p><p>G Spies, F Ahmed, C Fennema-Notestine, S Archibald, S Seedat</p><p><strong>95. Nicotine-stimulated release of hippocampal norepinephrine is reduced in an animal model of attention-deficit/ hyperactivity disorder: the spontaneously hypertensive rat</strong></p><p>T Sterley</p><p><strong>96. Brain-derive neurotrophic factor (BDNF) protein levels in anxiety disorders: Systematic review and meta-regression analysis</strong></p><p>S Suliman, S M J Hemmings, S Seedat</p><p><strong>97. A 12-month retrospective audit of the demographic and clinical profile of mental healthcare users admitted to a district level hospital in the Western Cape, South Africa</strong></p><p>E Thomas, K J Cloete, M Kidd, H Lategan</p><p><strong>98. Magnesium recurarization: A comparison between reversal of neuromuscular block with sugammadex v. neostigmine/ glycopyrrolate in an <em>in vivo</em> rat model</strong></p><p><strong></strong>M van den Berg, M F M James, L A Kellaway</p><p><strong>99. Identification of breast cancer patients at increased risk of 'chemobrain': Case study and review of the literature</strong></p><p>N van der Merwe, R Pienaar, S J van Rensburg, J Bezuidenhout, M J Kotze</p><p><strong>100. The protective role of HAART and NAZA in HIV Tat protein-induced hippocampal cell death</strong></p><p>S Zulu, W M U Daniels, M V Mabandla</p>

CNS disorders are lagging behind other indications in implementing genotype-dependent treatment algorithms for personalized medicine. This report uses a biophysically realistic computer model of an associative and dorsal motor cortico-striatal-thalamo-cortical loop and a working memory cortical model to investigate the pharmacodynamic effects of COMTVal158Met rs4680, 5-HTTLPR rs 25531 s/L and D2DRTaq1A1 genotypes on the clinical response of 7 antipsychotics. The effect of the genotypes on dopamine and serotonin dynamics and the level of target exposure for the drugs was calibrated from PET displacement studies. The simulations suggest strong gene-gene pharmacodynamic interactions unique to each antipsychotic. For PANSS Total, the D2DRTaq1 allele has the biggest impact, followed by the 5-HTTLPR rs25531. The A2A2 genotype improved efficacy for all drugs, with a more complex outcome for the 5-HTTLPR rs25531 genotype. Maximal range in PANSS Total for all 27 individual combinations is 3 (aripiprazole) to 5 points (clozapine). The 5-HTTLPR L/L with aripiprazole and risperidone and the D2DRTaq1A2A2 allele with haloperidol, clozapine and quetiapine reduce the motor side-effects with opposite effects for the s/s genotype. The COMT genotype has a limited effect on antipsychotic effect and EPS. For cognition, the COMT MM 5-HTTLPR L/L genotype combination has the best performance for all antipsychotics, except clozapine. Maximal difference is 25% of the total dynamic range in a 2-back working memory task. Aripiprazole is the medication that is best suited for the largest number of genotype combinations (10) followed by Clozapine and risperidone (6), haloperidol and olanzapine (3) and quetiapine and paliperidone for one genotype. In principle, the platform could identify the best antipsychotic treatment balancing efficacy and side-effects for a specific individual genotype. Once the predictions of this platform are validated in a clinical setting the platform has potential to support rational personalized treatment guidance in clinical practice.

An extensive literature regarding gender differences relevant to several aspects of schizophrenia is nowadays available. It includes some robust findings as well as some inconsistencies. In the present review, we summarize the literature on gender differences in schizophrenia relevant to clinical and social outcome as well as their determinants, focusing on clinical variables, while gender differences on biological factors which may have an impact on the outcome of the disorder were not included herewith. Consistent findings include, in male with respect to female patients, an earlier age of illness onset limited to early- and middle-onset schizophrenia, a worse premorbid functioning, a greater severity of negative symptoms, a lower severity of affective symptoms and a higher rate of comorbid alcohol/substance abuse. Discrepant findings have been reported on gender differences in positive symptoms and in social and non-social cognition, as well as in functional outcome and rates of recovery. In fact, despite the overall finding of a more severe clinical picture in males, this does not seem to translate into a worse outcome. From the recent literature emerges that, although some findings on gender differences in schizophrenia are consistent, there are still aspects of clinical and functional outcome which need clarification by means of further studies taking into account several methodological issues.

Mental health care users (MHCUs) living with schizophrenia experience an altered reality with regard to cognition and perceptions. Research shows that between 37% and 58% of patients diagnosed with schizophrenia relapse due to poor treatment compliance; lack of insight into their illness; and non-adherence to medication. The aim of the current study was to explore and describe the views of family members on preventing and managing relapse of MHCUs, and their support needs with regard to preventing and managing relapse of MHCUs at a selected government psychiatric hospital in Gauteng, South Africa. An exploratory, descriptive and contextual research design was followed. Fourteen family members of MHCUs were purposively sampled from the hospital outpatient department. Data was collected through in-depth individual interviews. Ethical considerations were adhered to, and approval was obtained from the Institutional Review Board and gatekeepers. Written informed consent was obtained from each participant. The findings of the study indicated that violence, financial burden, emotional burden and stigmatisation by the community were challenges experienced by family members. The family members were of the view that substance use and non-adherence led to relapse of MHCUs. Thus, the family members viewed themselves as a source of emotional support who provided supervision and monitoring. Enhanced health care provider support and improved health care services to MHCUs and their family members are needed. Relapse could be addressed by means of a holistic integrated and multidisciplinary approach to the care, treatment and rehabilitation of MHCUs.

Several behaviors, including compulsive gambling, have been considered non-substance-related addictive disorders. Categorical mental disorders (e.g., DSM-5) are usually accompanied by very different symptomatic expressions (affective, behavioral, cognitive, substance abuse, personality traits). When these mental disorders occur with addictive disorders, either concomitantly or sequentially over the life span, this clinical condition is called a dual disorder. Gambling disorder (GD) has been associated with other categorical psychiatric diagnoses: attention deficit hyperactivity disorder, depression, bipolar disorder, social anxiety, schizophrenia, substance use disorder, antisocial personality disorder; and dimensional symptoms including higher impulsivity, poorer emotional wellbeing, cognitive distortion, psychosis, deficient self-regulation, suicide, poorer family environment, and greater mental distress. We are calling this clinical condition Gambling Dual Disorder. From a clinical perspective, it is clear that Gambling Dual Disorder is not the exception but rather the expectation, and this holds true not just for GD, but also for other mental disorders including other addictions. Mental disorders are viewed as biological disorders that involve brain circuits that implicate specific domains of cognition, emotion, and behavior. This narrative review presents the state of the art with respect to GD in order to address current matters from a dual disorder, precision psychiatry, and clinical neuroscience perspective, rather than the more subjective approach of symptomatology and clinical presentation. This review also presents Gambling Dual Disorder as a brain and neurodevelopmental disorder, including from the perspectives of evolutionary psychiatry, genetics, impulsivity as an endophenotype, the self-medication hypothesis, and sexual biological differences. The wide vision of the disease advances a paradigm shift, highlighting how GD and dual disorders should be conceptualized, diagnosed, and treated. Rethinking GD as part of a dual disorder is crucial for its appropriate conceptualization from the perspective of clinical neuroscience and precision psychiatry.

Abstract Understanding longitudinal cognitive performance in individuals at ultra-high risk for psychosis (UHR) is important for informing theoretical models and treatment. A vital step in this endeavor is to determine whether there are UHR subgroups that have similar patterns of cognitive change over time. The aims were to: i) identify latent class trajectories of cognitive performance over 12-months in UHR individuals, ii) identify baseline demographic and clinical predictors of the resulting classes, and iii) determine whether trajectory classes were associated with transition to psychosis or functional outcomes. Cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) at baseline, 6- and 12-months (N = 288). Using Growth Mixture Modeling, a single unimpaired improving trajectory class was observed for motor function, speed of processing, verbal fluency, and BACS composite. A two-class solution was observed for executive function and working memory, showing one unimpaired and a second impaired class. A three-class solution was found for verbal learning and memory: unimpaired, mildly impaired, and initially extremely impaired, but improved (“caught up”) to the level of the mildly impaired. IQ, omega-3 index, and premorbid adjustment were associated with class membership, whereas clinical variables (symptoms, substance use), including transition to psychosis, were not. Working memory and verbal learning and memory trajectory class membership was associated with functioning outcomes. These findings suggest there is no short-term progressive cognitive decline in help-seeking UHR individuals, including those who transition to psychosis. Screening of cognitive performance may be useful for identifying UHR individuals who may benefit from targeted cognitive interventions.

In the human brain, the cerebellum (CB) and basal ganglia (BG) are implicated in cognition-, emotion-, and motor-related cortical processes and are highly interconnected, both to cortical regions via separate, trans-thalamic pathways and to each other via subcortical disynaptic pathways. We previously demonstrated a distinction between cognitive and motor CB-BG networks (CCBN, MCBN, respectively) as it relates to cortical network integration in healthy young adults, suggesting the subcortical networks separately support cortical networks. The CB and BG are also implicated in the pathophysiology of schizophrenia, Parkinson's, and compulsive behavior; thus, integration within subcortical CB-BG networks may be related to transdiagnostic symptomology. Here, we asked whether CCBN or MCBN integration predicted Achenbach Self-Report scores for anxiety, depression, intrusive thoughts, hyperactivity and inactivity, and cognitive performance in a community sample of young adults. We computed global efficiency for each CB-BG network and 7 canonical resting-state networks for all right-handed participants in the Human Connectome Project 1200 release with a complete set of preprocessed resting-state functional MRI data (N = 783). We used multivariate regression to control for substance abuse and age, and permutation testing with exchangeability blocks to control for family relationships. MCBN integration negatively predicted depression and hyperactivity, and positively predicted cortical network integration. CCBN integration predicted cortical network integration (except for the emotional network) and marginally predicted a positive relationship with hyperactivity, indicating a potential dichotomy between cognitive and motor CB-BG networks and hyperactivity. These results highlight the importance of CB-BG interactions as they relate to motivation and symptoms of depression.

Abstract Background Patients with psychiatric disorders often experience cognitive dysfunction, but the precise relationship between cognitive deficits and psychopathology remains unclear. We investigated the relationships between domains of cognitive functioning and psychopathology in a transdiagnostic sample using a data-driven approach. Methods Cross-sectional network analyses were conducted to investigate the relationships between domains of psychopathology and cognitive functioning and detect clusters in the network. This naturalistic transdiagnostic sample consists of 1016 psychiatric patients who have a variety of psychiatric diagnoses, such as depressive disorders, anxiety disorders, obsessive−compulsive and related disorders, and schizophrenia spectrum and other psychotic disorders. Psychopathology symptoms were assessed using various questionnaires. Core cognitive domains were assessed with a battery of automated tests. Results Network analysis detected three clusters that we labelled: general psychopathology, substance use, and cognition. Depressive and anxiety symptoms, verbal memory, and visual attention were the most central nodes in the network. Most associations between cognitive functioning and symptoms were negative, i.e. increased symptom severity was associated with worse cognitive functioning. Cannabis use, (subclinical) psychotic experiences, and anhedonia had the strongest total negative relationships with cognitive variables. Conclusions Cognitive functioning and psychopathology are independent but related dimensions, which interact in a transdiagnostic manner. Depression, anxiety, verbal memory, and visual attention are especially relevant in this network and can be considered independent transdiagnostic targets for research and treatment in psychiatry. Moreover, future research on cognitive functioning in psychopathology should take a transdiagnostic approach, focusing on symptom-specific interactions with cognitive domains rather than investigating cognitive functioning within diagnostic categories.

A common ground between mental health and judicial-legal domains concerns concepts like “care”, “control” and “possibility to foresee” human behaviour, with particular reference to the “social dangerousness”. The connections between these sense-making practices can be traced by discursive modulation of “certainty/uncertainty”. This study aimed to highlight the discursive peculiarities of a specific socio-cultural context and genre, namely scientific papers. The corpus of data consisted in a selection of 30 papers published by the BJP (from 1975 to 2015), on subjects concerning forensic psychiatry, subjected to Content Analysis and Critical Discourse Analysis. Results showed that the papers adopted two main socio-epistemic rhetorics. On one side, the enunciators proceeded in an “assertive” and rigorous manner through a social-epistemic rhetoric of “reassurance”; on the other side, they gave voice to rhetoric of the “limit”, lacking any cognitive “closure”. References Bakhtin, M.M. (1979). Estetika slovesnogo tvorcestva. Moskow: Iskusstvo. Bennett, T., Holloway, K., & Farrington, D. (2008). The statistical association between drug misuse and crime: A meta-analysis. Aggression and Violent Behavior, 13, 107-118. Berlin, J.A. (1993). Post-structuralism, semiotics, and social-epistemic rhetoric: Converging agendas. In T. Enos & S. Brown (Eds.), Defining the new rhetoric (pp. 137-176). Newbury Park, CA: Sage. Caffi, C. (2001). La mitigazione. Un approccio pragmatico alla comunicazione nei contesti terapeutici [Mitigation. A pragmatic approach to communication within therapeutic contexts]. Münster: LIT Verlag. Cantarini, S., Abraham, W., & Leiss, E. (Eds.) (2014). Certainty-uncertainty – and the Attitudinal Space in Between [SLCS 165]. Amsterdam: John Benjamin. Catanesi, R., Carabellese, F., & Grattagliano, I. (2009). Cura e controllo. Come cambia la pericolosità sociale psichiatrica [Treatment and control. How has the concept of psychiatric social danger changed]. Giornale Italiano di Psicopatologia, 15,: 64-74. Crismore, A., Markannen, R., & Steffenson, M. (1993). Metadiscourse in persuasive writing: A study of texts written in American and Finnish University students. Written Communication, 10 (1), 39-71. Fairclough, N. (2003). Analysing Discourse: Textual Analysis for Social Research. London: Routledge. Foucault, M. (1972). The Archaeology of Knowledge and The Discourse on Language. New York: Pantheon Books. Grevi, V. (2006). Prove [Proof]. In V. Grevi & G. Conso (Eds.), Compendio di procedura penale [Handbook of penal procedure](pp. 313-406). Padua: Cedam. Grice, P.H. (1975). Logic and conversation. In P. Cole & J.L. Morgan (Eds.), Syntax and semantics, Vol. 3: Speech acts (pp. 41-58). New York: Academic Press. Gross, A.G., Harmon, J.E., & Reidy, M.S. (2002). Communicating Science. The Scientific Paper from the 17th Century to the Present. New York: Oxford University Press. Hermans, H. J. M., & Gieser, T. (Eds.). (2012). Handbook of Dialogical Self Theory. Cambridge, U.K.: Cambridge University Press. Hyland, K. (1996). Writing without conviction? Hedging in scientific research articles. Applied Linguistics, 17 (4), 433-454. Hyland, K. (1998). Boosting, hedging and the negotiation of academic knowledge. TEXT, 18(3), 349-382. Hyland, K. (2001). Bringing in the reader: addressee features in academic articles. Written Communication, 18 (4), 549-574. Junginger, J. (1996), Psychosis and violence: the case for a content analysis of psychotic experience. Schizophrenia Bulletin, 22, 91-103. Kaliski, S.Z. (2002). A comparison of risk factors for habitual violence in pre-trial subjects. Acta Psychiatrica Scandinavica, 106 (412), 58-61. Kockelman, P. (2007) Agency: The Relation between Meaning, Power, and Knowledge, Current Anthropology, 48 (3), 375-401. Lamb, H., & Weimberger, L. (1998). Persons with severe mental illness in jails and prisons: A review. Psychiatric Services, 49, 483-492. Lancia, F. (2004). Strumenti per l'analisi dei testi. Introduzione all'uso di T-LAB [Instruments for Text Analysis. Introduction to the Use of T-LAB]. Milano: Franco Angeli. Lindqvist, P., & Allebeck, P. (1990), Schizophrenia and crime: a longitudinal follow-up of 644 schizophrenics in Stockolm. British Journal of Psychiatry, 157, 345-350. Marzuk, P. (1996), Violence, crime and mental illness: How strong a link? Archives of General Psychiatry, 53, 481-486. Mininni, G., & Manuti, A. (2017). A rose is more than a rose… The diatextual constitution of subjects and objects. Text & Talk, 37 (2), 243-263. Mininni, G., Manuti, A., Scardigno, R., Rubino, R. (2014). Old roots, new branches: The shoot of diatextual analysis. Qualitative Research in Psychology, 11, 1-16. Mininni, G., Scardigno, R. & Grattagliano, I. (2014). The dialogic construction of certainty in legal contexts. Language & Dialogue. Special issue Certainty and Uncertainty in dialogue, 4 (1), 112-131. Monahan, J. (1997). Clinical and actuarial predictions of violence. In D. Faigman, D. Kaye & M. Saxs (Eds.) Modern scientific evidence: the law and science of expert testimony (pp. 300-318). New York: West. Mullen, P. (2000). Forensic mental health. British Journal of Psychiatry, 176, 307-311. Rasanen, P., Tiihonen, J., Isohanni, M. (1998). Schizophrenia, alcohol abuse and violent behaviour: A 26-year follow-up study of an unselected birth cohort. Schizophrenia Bulletin, 24, 437-41. Salvatore, S., Gelo, O.C., Gennaro, A., Metrangolo, R., Terrone, G., Pace, V., Venuleo, C., Venezia, A., & Ciavolino, E. (2017). An automated method of content analysis for psychotherapy research: A further validation. Psychotherapy Research, 27 (1),38–50. Salvatore, S., & Valsiner, J. (2011). Idiographic science as a nonexisting object: The importance of the reality of the dynamic system. In S. Salvatore, J. Valsiner, A. Gennaro, & J.B. Travers Simon (Eds.), YIS: Yearbook of idiographic science (Vol. 3) (pp. 7-26). Rome: Firera & Liuzzo. Shah, S.A. (1978). Dangerousness and Mental Ilness: Some Conceptual, Prediction and Policy Dilemmas. In C. Frederick (Ed.) Dangerous behaviour: A problem in Law and mental health (pp. 153-191). Rockville, MD: NIMH, Washington. Steadman, H. J., & Cocozza J. J. (1974). Careers of the criminally insane: Excessive social control of deviance. Lexington, MA: Lexington Books, D.C. Heath. Swanson, J., Estroff, S., Swartz, M., Borum, R., Lachicotte, W., Zimmer C., & Wagner, R. (1997). Violence and severe mental disorder in clinical and community populations: the effects of psychotic symptoms, comorbidity and lack of treatment. Psychiatry, 60, 1-22. Swartz, M., Swanson, J., & Hiday, V. (1998), Violence and severe mental illness: The effects of substance abuse and nonadherence to medication. American Journal of Psychiatry, 155, 226-231. Torrey, E. (1994). Violent behaviour by individuals with serious mental illness. Hospital & Community Psychiatry, 45, 653-662. Valsiner, J. (2007). Culture in minds and societies. Foundations of cultural psychology. New Delhi: Sage. Van Dijk, T.A. (2008). Discourse and Power. Houndsmills: Palgrave. Walsh, E., Buchanan, A., & Fahy, T. (2002). Violence and schizophrenia: examining the evidence. British Journal of Psychiatry, 180, 490-495. Wodak, R., & Meyer, M. (2009). Methods of critical discourse analysis. Thousand Oaks, CA: Sage.

This paper will compare the metaphoric structuring of the ecological concept of resilience—with its roots in Holling's 1973 paper; with psychological concepts of resilience which followed from research—such as Werner, Bierman, and French and Garmezy and Streitman) published in the early 1970s. This metaphoric analysis will expose the difference between complex adaptive systems models of resilience in ecology and studies related to resilience in relation to climate change; compared with the individualism of linear equilibrium models of resilience which have dominated discussions of resilience in psychology and economics. By examining the ontological commitments of these competing metaphors, I will show that the individualistic concept of resilience which dominates psychological discussions of resilience is incompatible with the ontological commitments of ecological concepts of resilience. Because the ontological commitments of the concepts of ecological resilience on the one hand, and psychological resilience on the other, are so at odds with one another, it is important to be clear which concept of resilience is being evaluated for its adequacy as a concept. Having clearly distinguished these competing metaphors and their ontological commitments, this paper will show that it is the complex adaptive systems model of resilience from ecology, not the individualist concept of psychological resilience, that has been utilised by both the academic discussions of adaptation to climate change, and the operationalisation of the concept of resilience by social movements like the permaculture, ecovillage, and Transition Towns movements. Ontological Metaphors My analysis of ontological metaphors draws on insights from Kuhn's (114) account of gestalt perception in scientific paradigm shifts; the centrality of the role of concrete analogies in scientific reasoning (Masterman 77); and the theorisation of ontological metaphors in cognitive linguistics (Gärdenfors). Figure 1: Object Ontological commitments reflect the shared beliefs within a community about the sorts of things that exist. Our beliefs about what exists are shaped by our sensory and motor interactions with objects in the physical world. Physical objects have boundaries and surfaces that separate the object from not-the-object. Objects have insides and outsides, and can be described in terms of more-or-less fixed and stable “objective” properties. A prototypical example of an “object” is a “container”, like the example shown in Figure 1. Ontological metaphors allow us to conceive of “things” which are not objects as if they were objects by picking “out parts of our experience and treat them as [if they were] discrete entities or substances of a uniform kind” (Lakoff and Johnson 25). We use ontological metaphors when we imagine a boundary around a collection of things, such as the members of a team or trees in a forest, and conceive of them as being in a container (Langacker 191–97). We can then think of “things” like a team or forest as if they were a single entity. We can also understand processes and activities as if they were things with boundaries. Whether or not we characterise some aspect of our experience as a noun (a bounded entity) or as a verb (a process that occurs over time) is not determined by the nature of things in themselves, but by our understanding and interpretation of our experience (Langacker 233). In this paper I employ a technique that involves examining the details of “concrete images” from the source domains for metaphors employed in the social sciences to expose for analysis their ontological commitments (Harrison, “Politics” 215; Harrison, “Economics” 7). By examining the ontological metaphors that structure the resilience literature I will show how different conceptions of resilience reflect different beliefs and commitments about the sorts of “things” there are in the world, and hence how we can study and understand these “things.” Engineering Metaphors In his discussion of engineering resilience, Holling (“Engineering Vs. Ecological” 33) argues that this conception is the “foundation for economic theory”, and defined in terms of “resistance to disturbance and the speed of return to the equilibrium” or steady state of the system. Whereas Holling takes his original example of the use of the engineering concept of resilience from economics, Pendall, Foster, & Cowell (72), and Martin-Breen and Anderies (6) identify it as the concept of resilience that dominates the field of psychology. They take the stress loading of bridges to be the engineering source for the metaphor. Figure 2: Pogo stick animation (Source: Blacklemon 67, CC http://en.wikipedia.org/wiki/File:Pogoanim.gif). In order to understand this metaphor, we need to examine the characteristics of the source domain for the metaphor. A bridge can be “under tension, compression or both forces at the same time [and] experiences what engineers define as stress” (Matthews 3). In order to resist these forces, bridges need to be constructed of material which “behave much like a spring” that “strains elastically (deforms temporarily and returns to its original shape after a load has been removed) under a given stress” (Gordon 52; cited in Matthews). The pogostick shown in Figure 2 illustrates how a spring returns to its original size and configuration once the load or stress is removed. WGBH Educational Foundation provides links to simple diagrams that illustrate the different stresses the three main designs of bridges are subject to, and if you compare Computers & Engineering's with Gibbs and Bourne's harmonic spring animation you can see how both a bridge under live load and the pogostick in Figure 2 oscillate just like an harmonic spring. Subject to the elastic limits of the material, the deformation of a spring is proportional to the stress or load applied. According to the “modern theory of elasticity [...] it [is] possible to deduce the relation between strain and stress for complex objects in terms of intrinsic properties of the materials it is made of” (“Hooke’s Law”). When psychological resilience is characterised in terms of “properties of individuals [that] are identified in isolation” (Martin-Breen and Anderies 12); and in terms of “behaviours and attributes [of individuals] that allow people to get along with one another and to succeed socially” (Pendall, Foster, and Cowell 72), they are reflecting this engineering focus on the properties of materials. Martin-Breen and Anderies (42) argue that “the Engineering Resilience framework” has been informed by ontological metaphors which treat “an ecosystem, person, city, government, bridge, [or] society” as if it were an object—“a unified whole”. Because this concept of resilience treats individuals as “objects,” it leads researchers to look for the properties or characteristics of the “materials” which individuals are “made of”, which are either elastic and allow them to “bounce” or “spring” back after stress; or are fragile and brittle and break under load. Similarly, the Designers Institute (DINZ), in its conference on “Our brittle society,” shows it is following the engineering resilience approach when it conceives of a city or society as an object which is made of materials which are either “strong and flexible” or “brittle and fragile”. While Holling characterises economic theory in terms of this engineering metaphor, it is in fact chemistry and the kinetic theory of gases that provides the source domain for the ontological metaphor which structures both static and dynamic equilibrium models within neo-classical economics (Smith and Foley; Mirowski). However, while springs are usually made out of metals, they can be made out of any “material [that] has the required combination of rigidity and elasticity,” such as plastic, and even wood (in a bow) (“Spring (device)”). Gas under pressure turns out to behave the same as other springs or elastic materials do under load. Because both the economic metaphor based on equilibrium theory of gases and the engineering analysis of bridges under load can both be subsumed under spring theory, we can treat both the economic (gas) metaphor and the engineering (bridge) metaphor as minor variations of a single overarching (spring) metaphor. Complex Systems Metaphors Holling (“Resilience & Stability” 13–15) critiques equilibrium models, arguing that non-deterministic, complex, non-equilibrium and multi-equilibrium ecological systems do not satisfy the conditions for application of equilibrium models. Holling argues that unlike the single equilibrium modelled by engineering resilience, complex adaptive systems (CAS) may have multi or no equilibrium states, and be non-linear and non-deterministic. Walker and Salt follow Holling by calling for recognition of the “dynamic complexity of the real world” (8), and that “these [real world] systems are complex adaptive systems” (11). Martin-Breen and Anderies (7) identify the key difference between “systems” and “complex adaptive systems” resilience as adaptive capacity, which like Walker and Salt (xiii), they define as the capacity to maintain function, even if system structures change or fail. The “engineering” concept of resilience focuses on the (elastic) properties of materials and uses language associated with elastic springs. This “spring” metaphor emphasises the property of individual components. In contrast, ecological concepts of resilience examine interactions between elements, and the state of the system in a multi-dimensional phase space. This systems approach shows that the complex behaviour of a system depends at least as much on the relationships between elements. These relationships can lead to “emergent” properties which cannot be reduced to the properties of the parts of the system. To explain these relationships and connections, ecologists and climate scientists use language and images associated with landscapes such as 2-D cross-sections and 3-D topology (Holling, “Resilience & Stability” 20; Pendall, Foster, and Cowell 74). Figure 3 is based on an image used by Walker, Holling, Carpenter and Kinzig (fig. 1b) to represent possible states of ecological systems. The “basins” in the image rely on our understanding of gravitational forces operating in a 3-D space to model “equilibrium” states in which the system, like the “ball” in the “basin”, will tend to settle. Figure 3: (based on Langston; in Walker et al. fig. 1b) – Tipping Point Bifurcation Wasdell (“Feedback” fig. 4) adapted this image to represent possible climate states and explain the concept of “tipping points” in complex systems. I have added the red balls (a, b, and c to replace the one black ball (b) in the original which represented the state of the system), the red lines which indicate the path of the ball/system, and the black x-y axis, in order to discuss the image. Wasdell (“Feedback Dynamics” slide 22) takes the left basin to represents “the variable, near-equilibrium, but contained dynamics of the [current] glacial/interglacial period”. As a result of rising GHG levels, the climate system absorbs more energy (mostly as heat). This energy can force the system into a different, hotter, state, less amenable to life as we know it. This is shown in Figure 3 by the system (represented as the red ball a) rising up the left basin (point b). From the perspective of the gravitational representation in Figure 3, the extra energy in the basin operates like the rotation in a Gravitron amusement ride, where centrifugal force pushes riders up the sides of the ride. If there is enough energy added to the climate system it could rise up and jump over the ridge/tipping point separating the current climate state into the “hot earth” basin shown on the right. Once the system falls into the right basin, it may be stuck near point c, and due to reinforcing feedbacks have difficulty escaping this new “equilibrium” state. Figure 4 represents a 2-D cross-section of the 3-D landscape shown in Figure 3. This cross-section shows how rising temperature and greenhouse gas (GHG) concentrations in a multi-equilibrium climate topology can lead to the climate crossing a tipping point and shifting from state a to state c. Figure 4: Topographic cross-section of possible climate states (derived from Wasdell, “Feedback” 26 CC). As Holling (“Resilience & Stability”) warns, a less “desirable” state, such as population collapse or extinction, may be more “resilient”, in the engineering sense, than a more desirable state. Wasdell (“Feedback Dynamics” slide 22) warns that the climate forcing as a result of human induced GHG emissions is in fact pushing the system “far away from equilibrium, passed the tipping point, and into the hot-earth scenario”. In previous episodes of extreme radiative forcing in the past, this “disturbance has then been amplified by powerful feedback dynamics not active in the near-equilibrium state [… and] have typically resulted in the loss of about 90% of life on earth.” An essential element of system dynamics is the existence of (delayed) reinforcing and balancing causal feedback loops, such as the ones illustrated in Figure 5. Figure 5: Pre/Predator model (Bellinger CC-BY-SA) In the case of Figure 5, the feedback loops illustrate the relationship between rabbit population increasing, then foxes feeding on the rabbits, keeping the rabbit population within the carrying capacity of the ecosystem. Fox predation prevents rabbit over-population and consequent starvation of rabbits. The reciprocal interaction of the elements of a system leads to unpredictable nonlinearity in “even seemingly simple systems” (“System Dynamics”). The climate system is subject to both positive and negative feedback loops. If the area of ice cover increases, more heat is reflected back into space, creating a positive feedback loop, reinforcing cooling. Whereas, as the arctic ice melts, as it is doing at present (Barber), heat previously reflected back into space is absorbed by now exposed water, increasing the rate of warming. Where negative feedback (system damping) dominates, the cup-shaped equilibrium is stable and system behaviour returns to base when subject to disturbance. [...]The impact of extreme events, however, indicates limits to the stable equilibrium. At one point cooling feedback loops overwhelmed the homeostasis, precipitating the "snowball earth" effect. […] Massive release of CO2 as a result of major volcanic activity […] set off positive feedback loops, precipitating runaway global warming and eliminating most life forms at the end of the Permian period. (Wasdell, “Topological”) Martin-Breen and Anderies (53–54), following Walker and Salt, identify four key factors for systems (ecological) resilience in nonlinear, non-deterministic (complex adaptive) systems: regulatory (balancing) feedback mechanisms, where increase in one element is kept in check by another element; modularity, where failure in one part of the system will not cascade into total systems failure; functional redundancy, where more than one element performs every essential function; and, self-organising capacity, rather than central control ensures the system continues without the need for “leadership”. Transition Towns as a Resilience Movement The Transition Town (TT) movement draws on systems modelling of both climate change and of Limits to Growth (Meadows et al.). TT takes seriously Limits to Growth modelling that showed that without constraints in population and consumption the world faces systems collapse by the middle of this century. It recommends community action to build as much capacity as possible to “maintain existence of function”—Holling's (“Engineering vs. Ecological” 33) definition of ecological resilience—in the face of failing economic, political and environmental systems. The Transition Network provides a template for communities to follow to “rebuild resilience and reduce CO2 emissions”. Rob Hopkins, the movements founder, explicitly identifies ecological resilience as its central concept (Transition Handbook 6). The idea for the movement grew out of a project by (2nd year students) completed for Hopkins at the Kinsale Further Education College. According to Hopkins (“Kinsale”), this project was inspired by Holmgren’s Permaculture principles and Heinberg's book on adapting to life after peak oil. Permaculture (permanent agriculture) is a design system for creating agricultural systems modelled on the diversity, stability, and resilience of natural ecosystems (Mollison ix; Holmgren xix). Permaculture draws its scientific foundations from systems ecology (Holmgren xxv). Following CAS theory, Mollison (33) defines stability as “self-regulation”, rather than “climax” or a single equilibrium state, and recommends “diversity of beneficial functional connections” (32) rather than diversity of isolated elements. Permaculture understands resilience in the ecological, rather than the engineering sense. The Transition Handbook (17) “explores the issues of peak oil and climate change, and how when looked at together, we need to be focusing on the rebuilding of resilience as well as cutting carbon emissions. It argues that the focus of our lives will become increasingly local and small scale as we come to terms with the real implications of the energy crisis we are heading into.” The Transition Towns movement incorporate each of the four systems resilience factors, listed at the end of the previous section, into its template for building resilient communities (Hopkins, Transition Handbook 55–6). Many of its recommendations build “modularity” and “self-organising”, such as encouraging communities to build “local food systems, [and] local investment models”. Hopkins argues that in a “more localised system” feedback loops are tighter, and the “results of our actions are more obvious”. TT training exercises include awareness raising for sensitivity to networks of (actual or potential) ecological, social and economic relationships (Hopkins, Transition Handbook 60–1). TT promotes diversity of local production and economic activities in order to increase “diversity of functions” and “diversity of responses to challenges.” Heinberg (8) wrote the forward to the 2008 edition of the Transition Handbook, after speaking at a TotnesTransition Town meeting. Heinberg is now a senior fellow at the Post Carbon Institute (PCI), which was established in 2003 to “provide […] the resources needed to understand and respond to the interrelated economic, energy, environmental, and equity crises that define the 21st century [… in] a world of resilient communities and re-localized economies that thrive within ecological bounds” (PCI, “About”), of the sort envisioned by the Limits to Growth model discussed in the previous section. Given the overlapping goals of PCI and Transition Towns, it is not surprising that Rob Hopkins is now a Fellow of PCI and regular contributor to Resilience, and there are close ties between the two organisations. Resilience, which until 2012 was published as the Energy Bulletin, is run by the Post Carbon Institute (PCI). Like Transition Towns, Resilience aims to build “community resilience in a world of multiple emerging challenges: the decline of cheap energy, the depletion of critical resources like water, complex environmental crises like climate change and biodiversity loss, and the social and economic issues which are linked to these. […] It has [its] roots in systems theory” (PCI, “About Resilience”). Resilience.org says it follows the interpretation of Resilience Alliance (RA) Program Director Brian Walker and science writer David Salt's (xiii) ecological definition of resilience as “the capacity of a system to absorb disturbance and still retain its basic function and structure.“ Conclusion This paper has analysed the ontological metaphors structuring competing conceptions of resilience. The engineering resilience metaphor dominates in psychological resilience research, but is not adequate for understanding resilience in complex adaptive systems. Ecological resilience, on the other hand, dominates in environmental and climate change research, and is the model of resilience that has been incorporated into the global permaculture and Transition Towns movements. References 2nd year students. Kinsale 2021: An Energy Descent Action Plan. Kinsale, Cork, Ireland: Kinsale Further Education College, 2005. 16 Aug. 2013 ‹http://transitionculture.org/wp-content/uploads/KinsaleEnergyDescentActionPlan.pdf>. Barber, Elizabeth. “Arctic Ice Continues to Thin, and Thin, European Satellite Reveals.” Christian Science Monitor 11 Sep. 2013. 25 Sep. 2013 ‹http://www.csmonitor.com/Environment/2013/0911/Arctic-ice-continues-to-thin-and-thin-European-satellite-reveals>. Bellinger, Gene. “Prey/Predator Model.” SystemsWiki 23 Nov. 2009. 16 Aug. 2013 ‹http://systemswiki.org/index.php?title=Prey/Predator_Model>. Blacklemon67. "Pogo Animation." Wikipedia 2007. 24 Sep. 2013 ‹http://en.wikipedia.org/wiki/File:Pogoanim.gif>. Computers & Engineering. Bridge Trucks Animated Stress Plot 1. 2003. GIF file. SAP2000 Bridge Design. ‹http://www.comp-engineering.com/announce/bridge/demo/truck_1.gif>. DINZ. “Resilience Engineering: 'Our Brittle Society' - The Sustainability Society - May 18th 2012.” The Designers Institute. 2013. 11 Aug. 2013 ‹http://www.dinz.org.nz/Events/2012/May/47965>. Gärdenfors, Peter. “Cognitive Semantics and Image Schemas with Embodied Forces.” Embodiment in Cognition and Culture. Ed. John Michael Krois et al. John Benjamins Publishing, 2007. 57–76. 8 Nov. 2012 ‹http://oddelki.ff.uni-mb.si/filozofija/files/Festschrift/Dunjas_festschrift/gardenfors.pdf>. Garmezy, N, and S Streitman. “Children at Risk: The Search for the Antecedents of Schizophrenia. Part I. Conceptual Models and Research Methods.” Schizophrenia Bulletin 8 (1974): 14–90. NCBI PubMed 14 Aug. 2013 ‹http://schizophreniabulletin.oxfordjournals.org/content/1/8/14.full.pdf>. Gibbs, Keith, and John Bourne. “The Helical Spring.” Schoolphysics 2013. 15 Aug. 2013 ‹http://www.schoolphysics.co.uk/animations/Helical_spring_shm/index.html>. Gordon, James Edward. Structures: Or, Why Things Don’t Fall Down. London: Plenum Press, 1978. Harrison, Karey. “Image Schemas and Political Ontology.” Communication, Cognition and Media: Political and Economic Discourse. Ed. Augusto Soares da Silva et al. Portugal: Aletheia, forthcoming. ———. “Ontological Commitments of Ethics and Economics.” Economic Thought 2.1 (2013): 1–19. 23 Apr. 2013 ‹http://et.worldeconomicsassociation.org/article/view/64>. Heinberg, Richard. Powerdown: Options and Actions for a Post-carbon World. New Society Publishers, 2004. Holling, Crawford Stanley. “Engineering Resilience versus Ecological Resilience.” Engineering within Ecological Constraints. Ed. Peter Schulze. Washington, DC: National Academy Press, 1996. 31–44. 11 Aug. 2013 ‹http://www.nap.edu/openbook.php?record_id=4919&page=31>. ———. “Resilience and Stability of Ecological Systems.” Annual Review of Ecology and Systematics 4.1 (1973): 1–23. 11 Aug. 2013 ‹http://webarchive.iiasa.ac.at/Admin/PUB/Documents/RP-73-003.pdf>. Holmgren, David. Permaculture: Principles & Pathways beyond Sustainability. Holmgren Design Services, 2002. Hopkins, Rob. “Kinsale Energy Descent Action Plan (2005).” Transition Culture: an Evolving Exploration into the Head, Heart and Hands of Energy Descent. n.d. 16 Aug. 2013 ‹http://transitionculture.org/essential-info/pdf-downloads/kinsale-energy-descent-action-plan-2005/>. ———. The Transition Handbook: From Oil Dependency to Local Resilience. Green Books, 2008. Print. ———. The Transition Handbook: From Oil Dependency to Local Resilience. Free edit version. ‹http://www.appropedia.org/Category:The_Transition_Handbook: Appropedia.org> 2010. 16 Aug. 2010 ‹http://www.cs.toronto.edu/~sme/CSC2600/transition-handbook.pdf>. Kuhn, Thomas. The Structure of Scientific Revolutions. 2nd ed. University of Chicago Press, 1962. Lakoff, George, and Mark Johnson. Metaphors We Live By. University of Chicago Press, 1980. Langacker, Ronald W. Foundations of Cognitive Grammar: Theoretical Prerequisites. Vol. 1. Stanford University Press, 1987. Langston, Art. “Tipping Point” or Bifurcation Between Two Attractor Basins. 2004. 25 Sep. 2013. ‹http://www.ecologyandsociety.org/vol9/iss2/art5/figure1.html>. Martin-Breen, Patrick, and J. Marty Anderies. Resilience: A Literature Review. Rockefeller Foundation, 2011. 8 Aug. 2013 ‹http://www.rockefellerfoundation.org/blog/resilience-literature-review>. Masterman, Margaret. “The Nature of a Paradigm.” Criticism and the Growth of Knowledge. Eds. Imre Lakatos & Alan Musgrave. Cambridge University Press, 1970. 59–89. Matthews, Theresa. “The Physics of Bridges.” Yale-New Haven Teachers Institute. 2013. 14 Aug. 2013 ‹http://www.yale.edu/ynhti/curriculum/units/2001/5/01.05.08.x.html>. Meadows, Donella H. et al. The Limits to Growth: A Report for the Club of Rome’s Project on the Predicament of Mankind. Universe Books, 1972. Mirowski, Philip. “From Mandelbrot to Chaos in Economic Theory.” Southern Economic Journal 57.2 (1990): 289–307. Mollison, Bill. Permaculture: A Designers’ Manual. Tagari Publications, 1988. PCI. “About.” Post Carbon Institute. 16 July 2012. 16 Aug. 2013 ‹http://www.postcarbon.org/about/>. ———. “About Resilience.org.” Resilience 16 July 2012. 16 Aug. 2013 ‹http://www.resilience.org/about>. Pendall, Rolf, Kathryn A. Foster, and Margaret Cowell. “Resilience and Regions: Building Understanding of the Metaphor.” Cambridge Journal of Regions, Economy and Society 3.1 (2010): 71–84. 4 Aug. 2013 ‹http://cjres.oxfordjournals.org/content/3/1/71>. RA. “About RA.” Resilience Alliance 2013. 16 Aug. 2013 ‹http://www.resalliance.org/index.php/about_ra>. Smith, Eric, and Duncan K. Foley. “Classical Thermodynamics and Economic General Equilibrium Theory.” Journal of Economic Dynamics and Control 32.1 (2008): 7–65. Transition Network. “About Transition Network.” Transition Network. 2012. 16 Aug. 2013 ‹http://www.transitionnetwork.org/about>. Walker, B. H., and David Salt. Resilience Thinking: Sustaining Ecosystems and People in a Changing World. Island Press, 2006. Walker, Brian et al. “Resilience, Adaptability and Transformability in Social–Ecological Systems.” Ecology and Society 9.2 (2004): 5. Wasdell, David. “A Topological Approach.” The Feedback Crisis in Climate Change: The Meridian Report. n.d. 16 Aug. 2013 ‹http://www.meridian.org.uk/Resources/Global%20Dynamics/Feedback%20Crisis/frameset1.htm?p=3>. ———. “Beyond the Tipping Point: Positive Feedback and the Acceleration of Climate Change.” The Foundation for the Future, Humanity 3000 Workshop. Seattle, 2006. ‹http://www.meridian.org.uk/_PDFs/BeyondTippingPoint.pdf>. ———. “Feedback Dynamics and the Acceleration of Climate Change.” Winterthur, 2008. 16 Aug. 2013 ‹http://www.crisis-forum.org.uk/events/Workshop1/Workshop1_presentations/wasdellpictures/wasdell_clubofrome.php>. Werner, Emmy E., Jessie M. Bierman, and Fern E. French. The Children of Kauai: A Longitudinal Study from the Prenatal Period to Age Ten. University of Hawaii Press, 1971.WGBH. “Bridge Basics.” Building Big. 2001. 14 Aug. 2013 ‹http://www.pbs.org/wgbh/buildingbig/bridge/basics.html>. Wikipedia contributors. “Gravitron.” Wikipedia, the Free Encyclopedia 20 Sep. 2013. 25 Sep. 2013 ‹http://en.wikipedia.org/wiki/Gravitron>. ———. “Hooke’s Law.” Wikipedia, the Free Encyclopedia 8 Aug. 2013. 15 Aug. 2013 ‹http://en.wikipedia.org/wiki/Hooke%27s_law>. ———. “Spring (device).” Wikipedia, the Free Encyclopedia 9 Aug. 2013. 24 Sep. 2013 ‹http://en.wikipedia.org/wiki/Spring_(device)>. ———. “System Dynamics.” Wikipedia, the Free Encyclopedia 9 Aug. 2013. 13 Aug. 2013 ‹http://en.wikipedia.org/wiki/System_dynamics>.

Looked at again and again half consciously by a mind thinking of something else, any object mixes itself so profoundly with the stuff of thought that it loses its actual form and recomposes itself a little differently in an ideal shape which haunts the brain when we least expect it. (Virginia Woolf 38) From briefcases to drugs, and from boxing rings to tower blocks, this issue of M/C Journal turns its attention to the diverse materialities that make up our social worlds. Across a variety of empirical contexts, the collected papers employ objects, structures, and spaces as lenses onto corporeality, extending and unsettling habitual understandings of what a body is and does. By exploring everyday encounters among bodies and other materialities, the contributors elucidate the material processes through which human corporeality is enacted and imagined, produced and unmade.That materialities “tell stories” of bodies is an implicit tenet of embodied existence. In biomedical practice, for example, the thermometer assigns a value to a disease process which might already be felt, whereas the blood pressure cuff sets in motion a story of illness that is otherwise hidden or existentially absent. In so doing, such objects recast corporeality, shaping not only experiences of embodied life, but also the very matter of embodiment.Whilst recognising that objects are “companion[s] in life experience” (Turkle 5), this issue seeks to go beyond a sole focus on embodied experience, and explore the co-constitutive entanglements of embodiment and materiality. The collected papers examine how bodies and the material worlds around them are dialectically forged and shaped. By engaging with a specific object, structure, or space, each paper reflects on embodiment in ways that take account of its myriad material dynamics. BodiesHow to conceptualise the body and attend to its complex relationships with sociality, identity, and agency has been a central question in many recent strands of thinking across the humanities and social sciences (see Blackman; Shilling). From discussions of embodiment and personhood to an engagement with the affective and material turns, these strands have challenged theoretical emphases on body/mind dualisms that have historically informed much thinking about bodies in Western thought, turning the analytic focus towards the felt experience of embodied being.Through these explorations of embodiment, the body, as Csordas writes, has emerged as “the existential ground of culture” (135). Inspired by phenomenology, and particularly by the writings of Merleau-Ponty, Csordas has theorised the body as always-already inter-subjective. In constant dynamic interaction with self, others, and the environment, the body is both creative and created, constituting culture while being constituted by it. As such, bodies continuously materialise through sensory experiences of oneself and others, spaces and objects, such that the embodied self is at once both material and social.The concept of embodiment—as inter-subjective, dynamic, and experientially focussed—is central to this collection of papers. In using the term corporeality, we build on the concept of embodiment in order to interrogate the material makings of bodies. We attend to the ways in which objects, structures, and spaces extend into, and emanate from, embodied experiences and bodily imaginings. Being inherently inter-subjective, bodies are therefore not individual, clearly bounded entities. Rather, the body is an "infinitely malleable and highly unstable culturally constructed product” (Shilling 78), produced, shaped, and negated by political and social processes. Studies of professional practice—for example, in medicine—have shown how the body is assembled through culturally specific, sometimes contingent, arrangements of knowledges and practices (Berg and Mol). Such arrangements serve to make the body inherently “multiple” (Mol) as well as mutable.A further challenge to entrenched notions of singularity and boundedness has been offered by the “affective turn” (Halley and Clough) in the humanities and social sciences (see also Gregg and Siegworth; Massumi; Stewart). Affect theory is concerned with the felt experiences that comprise and shape our being-in-the-world. It problematises the discursive boundaries among emotive and visceral, cognitive and sensory, experiences. In so doing, the affective turn has sought to theorise inter-subjectivity by engaging with the ways in which bodily capacities arise in relation to other materialities, contexts, and “force-relations” (Seigworth and Gregg 4). In attending to affect, emphasis is placed on the unfinishedness of both human and non-human bodies, showing these to be “perpetual[ly] becoming (always becoming otherwise)” (3, italics in original). Affect theory thereby elucidates that a body is “as much outside itself as in itself” and is “webbed in its relations” (3).ObjectsIn parallel to the “affective turn,” a “material turn” across the social sciences has attended to “corporeality as a practical and efficacious series of emergent capacities” which “reveals both the materiality of agency and agentic properties inherent in nature itself” (Coole and Frost 20). This renewed attention to the “stuff” (Miller) of human and non-human environments and bodies has complemented, but also challenged, constructivist theorisations of social life that tend to privilege discourse over materiality. Engaging with the “evocative objects” (Turkle) of everyday life has thereby challenged any assumed distinction between material and social processes. The material turn has, instead, sought to take account of “active processes of materialization of which embodied humans are an integral part, rather than the monotonous repetitions of dead matter from which human subjects are apart” (Coole and Frost 8).Key to this material turn has been a recognition that matter is not lumpen or inert; rather, it is processual, emergent, and always relational. From Bergson, through Deleuze and Guattari, to Bennett and Barad, a focus on the “vitality” of matter has drawn questions about the agency of the animate and inanimate to the fore. Engaging with the agentic capacities of the objects that surround us, the “material turn” recognises human agency as always embedded in networks of human and non-human actors, all of whom shape and reshape each other. This is an idea influentially articulated in Actor-Network-Theory (Latour).In an exposition of Actor-Network-Theory, Latour writes: “Scallops make the fisherman do things just as nets placed in the ocean lure the scallops into attaching themselves to the nets and just as data collectors bring together fishermen and scallops in oceanography” (107, italics in original). Humans, non-human animals, objects, and spaces are thus always already entangled, their capacities realised and their movements motivated, directed, and moulded by one another in generative processes of responsive action.Embodied Objects: The IssueAt the intersections of a constructivist and materialist analysis, Alison Bartlett’s paper draws our attention to the ways in which “retro masculinity is materialised and embodied as both a set of values and a set of objects” in Nancy Meyers’s film The Intern. Bartlett engages with the business suit, the briefcase, and the handkerchief that adorn Ben the intern, played by Robert De Niro. Arguing that his “senior white male body” is framed by the depoliticised fetishisation of these objects, Bartlett elucidates how they construct, reinforce, or interrupt the gaze of others. The dynamics of the gaze are also the focus of Anita Howarth’s analysis of food banks in the UK. Howarth suggests that the material spaces of food banks, with their queues of people in dire need, make hunger visible. In so doing, food banks draw hunger from the hidden depths of biological intimacy into public view. Howarth thus calls attention to the ways in which individual bodies may be caught up in circulating cultural and political discursive regimes, in this case ones that define poverty and deservingness. Discursive entanglements also echo through Alexandra Littaye’s paper. Like Bartlett, Littaye focusses on the construction and performance of gender. Autoethnographically reflecting on her experiences as a boxer, Littaye challenges the cultural gendering of boxing in discourse and regulation. To unsettle this gendering, Littaye explores how being punched in the face by male opponents evolved into an experience of camaraderie and respect. She contends that the boxing ring is a unique space in which violence can break down definitions of gendered embodiment.Through the changing meaning of such encounters between another’s hand and the mutable surfaces of her face, Littaye charts how her “body boundaries were profoundly reconfigured” within the space of the boxing ring. This analysis highlights material transformations that bodies undergo—agentially or unagentially—in moments of encounter with other materialities, which is a key theme of the issue. Such material transformation is brought into sharp relief by Fay Dennis’s exploration of drug use, where ways of being emerge through the embodied entanglements of personhood and diamorphine, as the drug both offers and reconfigures bodily boundaries. Dennis draws on an interview with Mya, who has lived experience of drug use, and addiction treatment, in London, UK. Her analysis parses Mya’s discursive construction of “becoming normal” through the everyday use of drugs, highlighting how drugs are implicated in creating Mya’s construction of a “normal” embodied self as a less vulnerable, more productive, being-in-the-world.Moments of material transformation, however, can also incite experiences of embodied extremes. This is elucidated by the issue’s feature paper, in which Roy Brockington and Nela Cicmil offer an autoethnographic study of architectural objects. Focussing on two Brutalist housing developments in London, UK, they write that they “feel small and quite squashable in comparison” to the buildings they traverse. They suggest that the effects of walking within one of these vast concrete entities can be likened to having eaten the cake or drunk the potion from Alice in Wonderland (Carroll). Like the boxing ring and diamorphine, the buildings “shape the physicality of the bodies interacting within them,” as Brockington and Cicmil put it.That objects, spaces, and structures are therefore intrinsic to, rather than set apart from, the dynamic processes through which human bodies are made or unmade ripples through this collection of papers in diverse ways. While Dennis’s paper focusses on the potentiality of body/object encounters to set in motion mutual processes of becoming, an interest in the vulnerabilities of such processes is shared across the papers. Glimpsed in Howarth’s, as well as in Brockington and Cicmil’s discussions, this vulnerability comes to the fore in Bessie Dernikos and Cathlin Goulding’s analysis of teacher evaluations as textual objects. Drawing on their own experiences of teaching at high school and college levels, Dernikos and Goulding analyse the ways in which teacher evaluations are “anything but dead and lifeless;” they explore how evaluations painfully intervene in or interrupt corporeality, as the words on the page “sink deeply into [one’s] skin.” These words thereby enter into and impress upon bodies, both viscerally and emotionally, their affective power unveiling the agency that imbues a lit screen or a scribbled page.Yet, importantly, this issue also demonstrates how bodies actively forge the objects, spaces, and environments they encounter. Paola Esposito’s paper registers the press of bodies on material worlds by exploring the collective act of walking with golden thread, a project that has since come to be entitled “Walking Threads.” Writing that the thread becomes caught up in “the bumpy path, trees, wind, and passers-by,” Esposito explores how these intensities and forms register on the moving collective of bodies, just as those bodies also press into, and leave traces on, the world around them. That diverse materialities thereby come to be imbued with, or perhaps haunted by, the material and affective traces of (other) bodies, is also shown by the metonymic resonance between Littaye’s face and her coach’s pad: each bears the marks of another’s punch. Likewise, in Bartlett’s analysis of The Intern, Ben is described as having “shaped the building where the floor dips over in the corner” due to the heavy printers he used in his previous, analogue era, job.This sense of the marks or fragments left by the human form perhaps emerges most resonantly in Michael Gantley and James Carney’s paper. Exploring mortuary practices in archaeological context, Gantley and Carney trace the symbolic imprint of culture on the body, and of the body on (material) culture; their paper shows how concepts of the dead body are informed by cultural anxieties and technologies, which in turn shape death rituals. This discussion thereby draws attention to the material, even molecular, traces left by bodies, long after those bodies have ceased to be of substance. The (im)material intermingling of human and non-human bodies that this highlights is also invoked, albeit in a more affective way, by Chris Stover’s analysis of improvisational musical spaces. Through a discussion of “musical-objects-as-bodies,” Stover shows how each performer leaves an imprint on the musical bodies that emerge from transient moments of performance. Writing that “improvised music is a more fruitful starting place for thinking about embodiment and the co-constitutive relationship between performer and sound,” Stover suggests that performers’ bodies and the music “unfold” together. In so doing, he approaches the subject of bodies beyond the human, probing the blurred intersections among human and non-human (im)materialities.Across the issue, then, the contributors challenge any neat distinction between bodies and objects, showing how diverse materialities “become” together, to borrow from Deleuze and Guattari. This blurring is key to Gantley and Carney’s paper. They write that “in post-mortem rituals, the body—formerly the manipulator of objects—becomes itself the object that is manipulated.” Likewise, Esposito argues that “we generally think of objects and bodies as belonging to different domains—the inanimate and the animate, the lifeless and the living.” Her paper shares with the others a desire to illuminate the transient, situated, and often vulnerable processes through which bodies and (other) materialities are co-produced. Or, as Stover puts it, this issue “problematise[s] where one body stops and the next begins.”Thus, together, the papers explore the many dimensions and materialities of embodiment. In writing corporeality, the contributors engage with a range of theories and various empirical contexts, to interrogate the material dynamics through which bodies processually come into being. The issue thereby problematises taken-for-granted distinctions between bodies and objects. The corporeality that emerges from the collected discussions is striking in its relational and dynamic constitution, in the porosity of (imagined) boundaries between self, space, subjects, and objects. As the papers suggest, corporeal being is realised through and within continuously changing relations among the visceral, affective, and material. Such relations not only make individual bodies, but also implicate socio-political and ecological processes that materialise in structures, technologies, and lived experiences. We offer corporeality, then, as a framework to illuminate the otherwise hidden, politically contingent, becomings of embodied beings. ReferencesBarad, Karen. “Posthumanist Performativity: Toward an Understanding of How Matter Comes to Matter.” Signs: Journal of Women in Culture and Society 28 (2003): 801–831.Bennett, Jane. Vibrant Matter: A Political Ecology of Things. Durham, NC: Duke UP, 2010.Berg, Marc, and Annemarie Mol (eds.) Differences in Medicine: Unraveling Practices, Techniques, and Bodies. Durham, NC: Duke, 1998.Bergson, Henri. Creative Evolution. London: Henry Holt and Company, 1911Blackman, Lisa. The Body: Key Concepts. London: Berg, 2008.Carroll, Lewis. Alice in Wonderland. London: Macmillan, 1865.Coole, Diana, and Samantha Frost. “Introducing the New Materialisms.” New Materialisms: Ontology, Agency, and Politics. Eds. Diana Coole and Samantha Frost. Durham, NC: Duke, 2010. 1-46.Csordas, Thomas J. “Somatic Modes of Attention.” Cultural Anthropology 8.2 (1993): 135-156.Deleuze, Gilles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia. London: Continuum, 2004.Gregg, Melissa, and Gregory Seigworth (eds.) The Affect Theory Reader. Durham, NC: Duke, 2010.Halley, Jean, and Patricia Ticineto Clough. The Affective Turn: Theorizing the Social. Durham, NC: Duke UP, 2007.Latour, Bruno. Reassembling the Social: An Introduction to Actor-Network-Theory. Oxford: Oxford UP, 2005.Massumi, Brian. The Politics of Affect. Cambridge: Polity Press, 2015.Merleau-Ponty, Maurice. Phenomenology of Perception. Trans. Colin Smith. London: Routledge, 1962Miller, Daniel. Stuff. Cambridge: Polity Press, 2010.Mol, Anemarie. The Body Multiple: Ontology in Medical Practice. Durham, NC: Duke UP, 2002.Seigworth, Gregory, and Melissa Gregg. “An Inventory of Shimmers.” The Affect Theory Reader. Eds. Melissa Gregg and Gregory Seigworth. Durham, NC: Duke, 2010. 1-28.Shilling, Chris. The Body and Social Theory. Nottingham: SAGE Publications, 2012.Stewart, Kathleen. Ordinary Affects. Durham, NC: Duke UP, 2007.Turkle, Sherry. “The Things That Matter.” Evocative Objects: Things We Think With. Ed. Sherry Turkle. Cambridge MA: MIT Press, 2007.Woolf, Virginia. Street Haunting. London: Penguin Books, 2005.

IntroductionThis article addresses the experience of designing and conducting life-writing workshops for a group of clients with severe mental illness; the aim of this pilot study was to begin to determine whether such writing about the self can aid in individual ‘recovery’, as that term is understood by contemporary health professionals. A considerable amount has been written about the potential of creative writing in mental health therapy; the authors of this article provide a brief summary of that literature, then of the concept of ‘recovery’ in a psychology and arts therapy context. There follows a first-hand account by one of the authors of being an arts therapy workshop facilitator in the role of a creative practitioner. This occurred in consultation with, and monitored by, experienced mental health professionals. Life-Writing as ‘Therapeutic’ Life-story or life-writing can be understood in this context as involving more than disclosure or oral expression of a subject’s ‘story’ as in psycho-therapy – life-story is understood as a written, structured narrative. In 2001, Wright and Chung published a review of the literature in which they claimed that writing therapy had been “restimulated by the development of narrative approaches” (278). Pennebaker argues that “catharsis or the venting of emotions” without “cognitive processing” has little therapeutic value and people need to “build a coherent narrative that explains some past experience” in order to benefit from writing” (Pennebaker, Telling Stories 10–11). It is claimed in the Clinical Psychology Review that life-writing has the therapeutic benefits of, for example, “striking physical health and behaviour change” (Esterling et al. 84). The reasons are still unclear, but it is possible that the cognitive and linguistic processing of problematic life-events through narrative writing may help the subject assimilate such problems (Alschuler 113–17). As Pennebaker and Seagal argue in the Journal of Clinical Psychology, the life-writing processallows one to organise and remember events in a coherent fashion while integrating thoughts and feelings ... This gives individuals a sense of predictability and control over their lives. Once an experience has structure and meaning, it would follow that the emotional effects of that experience are more manageable. (1243)It would seem reasonable to suggest that life-writing which constructs a positive recovery narrative can have a positive therapeutic effect, providing a sense of agency, connectedness and creativity, in a similar, integrating manner. Humans typically see their lives as stories. Paul Eakin stresses the link between narrative and identity in both this internal life-story and in outwardly constructed autobiography:narrative is not merely a literary form but a mode of phenomenological and cognitive self-experience, while self – the self of autobiographical discourse - does not necessarily precede its constitution in narrative. (Making Selves 100)So both a self-in-time and a socially viable identity may depend on such narrative. The term ‘dysnarrativia’ has been coined to describe the documented inability to construct self-narrative by those suffering amnesia, autism, severe child abuse or brain damage. The lack of ability to achieve narrative construction seems to be correlated with identity disorders (Eakin, Fictions in Autobiography 124). (For an overview of the current literature on creative and life-writing as therapy see Murphy & Neilsen). What is of particular relevance to university creative writing practitioners/teachers is that there is evidence, for example from Harvard psychiatrist Judith Herman and creative writing academic Vicki Linder, that life-narratives are more therapeutically effective if guided to be written according to fundamental ‘effective writing’ aesthetic conventions – such as having a regard to coherent structure in the narrative, the avoidance of cliché, practising the ‘demonstrate don’t state’ dictum, and writing in one’s own voice, for example. Defining ‘Recovery’There remains debate as to the meaning of recovery in the context of mental health service delivery, but there is agreement that recovery entails significantly more than symptom remission or functional improvement (Liberman & Kopelowicz). In a National Consensus Statement, the Substance Abuse and Mental Health Services Administration (SAMHSA) unit of the US Department of Health and Human Services in 2005 described recovery (in general terms) as being achieved by the enabling of a person with a mental illness to live meaningfully in a chosen community, while also attempting to realize individual potential. ‘Recovery’ as a central concept behind rehabilitation can be understood both as objective recovery – that is, in terms of noting a reduction in objective indicators of illness and disability (such as rates of hospital usage or unemployment) and a greater degree of social functioning – and also as subjective recovery. Subjective recovery can be ascertained by listening closely to what clients themselves have said about their own experiences. It has been pointed out (King, Lloyd & Meehan 2) that there is not always a correspondence between objective indicators of recovery and the subjective, lived experience of recovery. The experience of mental illness is not just one of symptoms and disability but equally importantly one of major challenge to sense of self. Equally, recovery from mental illness is experienced not just in terms of symptoms and disability but also as a recovery of sense of self … Recovery of sense of self and recovery with respect to symptoms and disability may not correspond. (King, Lloyd & Meehan; see also Davidson & Strauss)Symptoms of disability can persist, but a person can have a much stronger sense of self or empowerment – that is still recovery. Illness dislocates the sense of self as part of a community and of a self with skills and abilities. Restoring this sense of empowerment is an aim of arts therapy. To put it another way, recovery is a complex process by which a client with a mental illness develops a sense of identity and agency as a citizen, as distinct from identification with illness and disability and passivity as a ‘patient’. The creative arts have gone well beyond being seen as a diversion for the mentally ill. In a comprehensive UK study of creative arts projects for clients with mental illness, Helen Spandler et al. discovered strong evidence that participation in creative activity promoted a sense of purpose and meaning, and assisted in “rediscovering or rebuilding an identity within and beyond that of someone with mental health difficulties” (795). Recovery is aided by people being motivated to achieve self-confidence through mastery and competence; by learning and achieving goals. Clearly this is where arts therapy could be expected or hoped to be effective. The aim of the pilot study was not to measure ‘creativity’, but whether involvement in what is commonly understood as a creative process (life-writing) can have flow-on benefits in terms of the illness of the workshop participant. The psychologists involved, though more familiar with visual arts therapy (reasonably well-established in Australia – in 2006, the ANZAT began publishing the Australian and New Zealand Journal of Art Therapy), thought creative writing could also be valuable. Preparation for and Delivery of the Workshops I was acutely aware that I had no formal training in delivering a program to clients with mental health illness. I was counselled during several meetings with experienced psychologists and a social worker that the participants in the three workshops over two weeks would largely be people who had degrees of difficulty in living independently, and could well have perceptual problems, could misjudge signals from outside and inside the group, and be on medication that could affect their degree of engagement. Some clients could have impaired concentration and cognition, and a deficit in volition. Participants needed to be free to leave and rejoin the workshops during the afternoon sessions. Attendance might well fall as the workshops progressed. Full ethical clearance was attained though the University of Queensland medical faculty (after detailed description of the content and conduct of the proposed workshops) and consent forms prepared for participants. My original workshop ‘kit’ to be distributed to participants underwent some significant changes as I was counselled and prepared for the workshops. The major adjustment to my usual choice of material and approach was made in view of the advice that recounting traumatic events can have a negative effect on some patients – at least in the short term. For the sake of both the individuals and the group as a whole this was to be avoided. I changed my initial emphasis on encouraging participants to recount their traumatic experiences in a cathartic way (as suggested by the narrative psychology literature), to encouraging them to recount positive narratives from their lives – narratives of ‘recovery’ – as I explain in more detail below. I was also counselled that clients with mental health problems might dwell on retelling their story – their case history – rather than reflecting upon it or using their creative and imaginative ability to shape a life-story that was not a catalogue of their medical history. Some participants did demonstrate a desire to retell their medical history or narrative – including a recurring theme of the difficulty in gaining continuity with one trusted medical professional. I gently guided these participants back to fashioning a different and more creative narrative, with elements of scene creation, description and so on, by my first listening intently to and acknowledging their medical narrative for a few minutes and then suggesting we try to move beyond that. This simple strategy was largely successful; several participants commented explicitly that they were tired of having to retell their medical history to each new health professional they encountered in the hospital system, for example. My principal uncertainty was whether I should conduct the workshops at the same level of complexity that I had in the past with groups of university students or community groups. While in both of those cohorts there will often be some participants with mental health issues, for the most part this possibility does not affect the level or kind of content of material discussed in workshops. However, within this pilot group all had been diagnosed with moderate to severe mental illness, mostly schizophrenia, but also bipolar disorder and acute depression and anxiety disorders. The fact that my credentials were only as a published writer and teacher of creative writing, not as a health professional, was also a strong concern to me. But the clients readily accepted me as someone who knew the difficulty of writing well and getting published. I stressed to them that my primary aim was to teach effective creative writing as an end in itself. That it might be beneficial in health terms was secondary. It was a health professional who introduced me and briefly outlined the research aims of the workshop – including some attempt to measure qualitatively any possible benefits. It was my impression that the participants did not have a diminished sense of my usefulness because I was not a health professional. Their focus was on having the opportunity to practice creative writing and/or participate in a creative group activity. As mentioned above, I had prepared a workshop ‘kit’ for the participants of 15 pages. It contained the usual guidelines for effective writing – extracts from professional writers’ published work (including an extract from my own published work – a matter of equity, since they were allowing me to read their work), and a number of writing exercises (using description, concrete and abstract words, narrative point of view, writing in scenes, show don’t tell). The kit contained extracts from memoirs by Hugh Lunn and Bill Bryson, as well as a descriptive passage from Charles Dickens. An extract from Inga Clendinnen’s 2006 account in Agamemnon’s Kiss: selected essays of her positive interaction with fellow cancer patients (a narrative with the underlying theme of recovery) was also valuable for the participants. I stressed to the group that this material was very similar to that used with beginning writers among university students. I described the importance of life-writing as follows: Life-writing is simply telling a story from your life and perhaps musing or commenting on it at the same time. When you write a short account of something chosen from your life, you are making a pattern, using your memory, using your powers of description – you are being creative. You are being a story-teller. And story-telling is one very important thing that makes us humans different from all other animals – and it is a way in which we find a lot of meaning in our lives.My central advice in the kit was: “Just try to be as honest as you can – and to remember as well as you can … being honest and direct is both the best and the easiest way to write memoir”. The only major difference between my approach with these clients and that with a university class was in the selection of possible topics offered. In keeping with the advice of the psychologists who were experts in the theory of ‘recovery’, the topics were predominantly positive, though one or two topics gave the opportunity to recount and/or explore a negative experience if the participant wanted to do so: A time when I was able to help another personA time when I realised what really mattered in lifeA time when I overcame a major difficultyA time when I felt part of a group or teamA time when I knew what I wanted to do with my lifeA time when someone recognised a talent or quality of mineA time I did something that I was proud of A time when I learned something important to meA memorable time when I lived in a certain house or suburbA story that begins: “Looking back, I now understand that …”The group expressed satisfaction with these topics, though they had the usual writing students’ difficulty in choosing the one that best suited them. In the first two workshops we worked our way through the kit; in the third workshop, two weeks later, each participant read their own work to the group and received feedback from their peers and me. The feedback was encouraged to be positive and constructive, and the group spontaneously adopted a positive reinforcement approach, applauding each piece of writing. Workshop DynamicsThe venue for the workshops was a suburban house in the Logan area of Brisbane used as a drop-in centre for those with mental illness, and the majority of the participants would be familiar with it. It had a large, breezy deck on which a round-table configuration of seating was arranged. This veranda-type setting was sheltered enough to enable all to be heard easily and formal enough to emphasise a learning event was taking place; but it was also open enough to encourage a relaxed atmosphere. The week before the first workshop I visited the house to have lunch with a number of the participants. This gave me a sense of some of the participants’ personalities and degree of engagement, the way they related to each other, and in turn enabled them to begin to have some familiarity with me and ask questions. As a novice at working with this kind of client, I found this experience extremely valuable, especially as it suggested that a relatively high degree of communication and cognition would be possible, and it reduced the anxiety I had about pitching the workshops at an appropriate level. In the course of the first workshop, the most initially sceptical workshop participant ended up being the most engaged contributor. A highly intelligent woman, she felt it would be too upsetting to write about negative events, but ultimately wrote a very effective piece about the empowerment she gained from caring for a stray cat and locating the owner. Her narrative also expressed her realisation that the pet was partly a replacement for spending time with her son, who lived interstate. Another strong participant previously had written a book-length narrative of her years of misdiagnoses and trauma in the hospital system before coming under the care of her present health professionals. The participant who had the least literacy skills was accepted by the group as an equal and after a while contributed enthusiastically. Though he refused to sign the consent form at the outset, he asked to do so at the close of the first afternoon. The workshop was comprised of clients from two health provider organisations; at first the two groups tended to speak with those they already knew (as in any such situation in the broader community), but by the third workshop a sense of larger group identity was being manifested in their comments, as they spoke of what ‘the group’ would like in the future – such as their work being published in some form. It was clear that, as in a university setting, part of the beneficial effect of the workshops came from group and face to face interaction. It would be more difficult to have this dimension of benefit achieved via a web-based version of the workshops, though a chat room scenario would presumably go some way towards establishing a group feeling. Web-based delivery would certainly suit participants who lacked mobility or who lived in the regions. Clearly the Internet is a vital social networking tool, and an Internet-based version of the workshops could well be attempted in the future. My own previous experience of community digital storytelling workshops (Neilsen, Digital Storytelling as Life-writing) suggests that a high degree of technical proficiency can not be expected across such a cohort; but with adequate technical support, a program (the usual short, self-written script, recorded voice-over and still images scanned from the participants’ photo albums, etc) could make digital storytelling a further dimension of therapeutic life-writing for clients with mental illness. One of the most useful teaching techniques in a class room setting is the judicious use of humour – to create a sense of sharing a perspective, and simply to make material more entertaining. I tested the waters at the outset by referring to the mental health worker sitting in the background, and declaring (with some comic exaggeration) my concern that if I didn’t run the workshop well he would report adversely on me. There was general laughter and this expression of my vulnerability seemed to defuse anxiety on the part of some participants. As the workshop progressed I found I could use both humorous extracts of life-writing and ad hoc comic comments (never at the expense of a participant) as freely as in a university class. Participants made some droll comments in the overall context of encouraging one another in their contributions, both oral and written. Only one participant exhibited some temporary distress during one of the workshops. I was allowing another participant the freedom to digress from the main topic and the participant beside me displayed agitation and sharply demanded we get back to the point. I apologised and acknowledged I had not stayed as focused as I should and returned to the topic. I suspect I had a fortunate first experience of such arts therapy workshops – and that this was largely due to the voluntary nature of the study and that most of the participants brought a prior positive experience of the workshop scenario, and prior interest in creative writing, to the workshops. Outcomes A significantly positive outcome was that only one of the nine participants missed a session (through ill-health) and none left during workshops. The workshops tended to proceed longer than the three hours allotted on each occasion. Post-workshop interviews were conducted by a psychologist with the participants. Detailed data is not available yet – but there was a clear indication by almost all participants that they felt the workshops were beneficial and that they would like to participate in further workshops. All but one agreed to have their life-writing included in a newsletter produced by one of the sponsors of the workshops. The positive reception of the workshops by the participants has encouraged planning to be undertaken for a wide-ranging longitudinal study by means of a significant number of workshops in both life-writing and visual arts in more than one city, conducted by a team of health professionals and creative practitioners – this time with sophisticated measurement instruments to gauge the effectiveness of art therapy in aiding ‘recovery’. Small as the workshop group was, the pilot study seems to validate previous research in the UK and US as we have summarised above. The indications are that significant elements of recovery (in particular, feelings of enhanced agency and creativity), can be achieved by life-writing workshops that are guided by creative practitioners; and that it is the process of narrative construction within life-writing that engages with or enhances a sense of self and identity. NoteWe are indebted, in making the summary of the concept of ‘recovery’ in health science terms, to work in progress by the following research team: Robert King, Tom O'Brien and Claire Edwards (School of Medicine, University of Queensland), Margot Schofield and Patricia Fenner (School of Public Health, Latrobe University). We are also grateful for the generous assistance of both this group and Seiji Humphries from the Richmond Queensland Fellowship, in providing preparation for the workshops. ReferencesAlschuler, Mari. “Lifestories – Biography and Autobiography as Healing Tools for Adults with Mental Illness.” Journal of Poetry Therapy 11.2 (1997): 113–17.Davidson, Larry and John Strauss. “Sense of Self in Recovery from Severe Mental Illness.” British Journal of Medical Psychology 65 (1992): 31–45.Eakin, Paul. Fictions in Autobiography: Studies of the Art of Self-Invention. Princeton: Princeton UP, 1985.———. How Our Lives Become Stories: Making Selves. Ithaca: Cornell UP, 1999.Esterling, B.A., L. L’Abate., E.J. Murray, and J.W. Pennebaker. “Empirical Foundations for Writing in Prevention and Psychotherapy: Mental and Physical Health Outcomes.” Clinical Psychology Review 19.1 (1999): 79–96.Herman, Judith. Trauma and Recovery: The Aftermath of Violence - from Domestic Abuse to Political Terror. New York: Basic Books, 1992.King, Robert, Chris Lloyd, and Tom Meehan. Handbook of Psychosocial Rehabilitation. Oxford: Blackwell Publishing, 2007.Liberman, Robert, and Alex Kopelowicz. “Recovery from Schizophrenia: A Criterion-Based Definition.” In Ralph, R., and P. Corrigan (eds). Recovery in Mental Illness: Broadening Our Understanding of Wellness. Washington, DC: APA, 2005.Linder, Vicki. “The Tale of two Bethanies: Trauma in the Creative Writing Classroom.” New Writing: The International Journal for the Practice and Theory of Creative Writing 1.1 (2004): 6–14Murphy, Ffion, and Philip Neilsen. “Recuperating Writers – and Writing: The Potential of Writing Therapy.” TEXT 12.1 (Apr. 2008). ‹http://www.textjournal.com.au/april08/murphy_neilsen.htm›.Neilsen, Philip. “Digital Storytelling as Life-Writing: Self-Construction, Therapeutic Effect, Textual Analysis Leading to an Enabling ‘Aesthetic’ for the Community Voice.” ‹http://www.speculation2005.qut.edu.au/papers/Neilsen.pdf›.Pennebaker, James W., and Janel D. Seagal. “Forming a Story: The Health Benefits of Narrative.” Journal of Clinical Psychology, 55.10 (1999): 1243–54.Pennebaker, James W. “Telling Stories: The Health Benefits of Narrative.” Literature and Medicine 19.1 (2000): 3–18.Spandler, H., J. Secker, L. Kent, S. Hacking, and J. Shenton. “Catching Life: The Contribution of Arts Initiatives to ‘Recovery’ Approaches in Mental Health.” Journal of Psychiatric and Mental Health Nursing 14.8 (2007): 791–799.Wright, Jeannie, and Man Cheung Chung. “Mastery or Mystery? Therapeutic Writing: A Review of the Literature.” British Journal of Guidance and Counselling, 29.3 (2001): 277–91.