Dissertations / Theses on the topic 'Schizophrenics Treatment'
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Marschinke, Kathleen. "Family interventions in the treatment of schizophrenia." Online version, 1999. http://www.uwstout.edu/lib/thesis/1999/1999marschinkek.pdf.
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Franco, Michelle E. "A behavioral treatment program for chronic schizophrenics." Scholarly Commons, 1997. https://scholarlycommons.pacific.edu/uop_etds/2305.
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I examined the effects of a residential treatment program on symptoms and mental health service use in 14 chronic schizophrenics. The clients chosen for this study were the most difficult clients in this population due to continued high service usage (i.e., time spent in locked facilities). All 14 clients had been in a locked facility at least 1 year immediately prior to treatment. The program included skills training, reinforcement for incompatible behavior, and a token economy. The clients' symptomology was recorded twice a day. My hypotheses were that symptoms would decrease due to the program, and clients mental health service use would also decrease in a 1 year follow-up. Mental health service use (time spent in a locked facility) did decrease dramatically after treatment. All 14 clients had a decrease in the amount of time spent in locked facilities after treatment. The total cost for these clients in locked facilities the year immediately prior to treatment was conservatively estimated at $776,500. The annualized figure of the total cost of these 14 clients after treatment was estimated at $44,775, saving San Joaquin County approximately $721,725 in 1 year. The results did not support the hypothesis that the program reliably decreases schizophrenic symptomology as we measured it.
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Schock, Sandra Lynn. "Difficulties in psychotherapy with a residual schizophrenic." Thesis, Rhodes University, 1991. http://hdl.handle.net/10962/d1007457.
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This work addresses some of the difficulties encountered while working in psychotherapy with a residual schizophrenic. While there is an abundance of literature on psychotherapy for schizophrenia, both supporting and also refuting its merit, what the literature fails to reveal is that there appears to be a class of schizophrenic who, while apsychotic and able to communicate in the everyday sense of the word, is in a psychic space which speaks of a break with the basic relational elements of the human order. The quality of the patient's psychic life is such that almost nothing of what the literature describes as useful and appropriate in working with schizophrenics seems to help in the psychotherapeutic work with this type of patient. This study describes these issues with relevance to a particular residual schizophrenic. The Illustrative-didactic case-study method was used to discuss the four-and- a-half month psychotherapy with this patient. The patient's early developmental history, premorbid personality functioning, family and interpersonal relationships, mental state, diagnosis and a rationale for psychotherapy were presented and considered in detail. The structure of the psychotherapeutic process was reviewed in depth. The hermeneutic guidelines to understanding the case were drawn from Object-Relations Psychoanalytic theory, particularly Balint, Khan, Karon & VandenBos, Bollas, Romanyshyn, Perry, Symington, Fordham and others. Various psychic and personality features, as unveiled through the psychotherapeutic process, were elaborated and the implications of these for the therapeutic endeavour were considered as follows: Firstly, the psychic space of the patient, which precluded mirroring, symbolization find object-relationship - and which made psychotherapy untenable, was discussed. Secondly, therapeutic ambivalence and other counter-transference issues were reviewed. Thirdly, the shadow sides of both therapeutic optimism and of psychotherapeutic change were considered. Fourthly, the issues of therapeutic failure and of other treatment possibilities for a residual schizophrenic patient were examined. It was concluded that there needs to be an important countertransference shift with regard to the psychotherapeutic goals for those patients whose condition may be chronic, and for whom it appears that psychotherapy is not going to be of any therapeutic benefit - find where an 'empathic accompaniment' might be as much as it is possible to hope for or achieve.
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Green, Asha M. "Participant Perspectives: Investigating the Experience of Low-Income Schizophrenics in Clinical Research Trials." Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc799519/.
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The continued investigation into the experiences of individuals with schizophrenia who participate in biomedical research trials is necessary in order to understand participants’ perspectives, motivations, attitudes, values, and beliefs. As important stakeholders in the clinical research process, participant feedback is significant and can help shed light on, not only their experiences, but also deepen understandings when it comes to clinical trial participants’ perceptions of informed consent and personal autonomy. Conducting ethical research demands the exploration of these issues and specifically targeting this vulnerable group helped to address a gap in the literature. This study was conducted for InSite Clinical Research and gathered data in the form of in-depth semi-structured interviews and a short survey instrument with 20 low-income adults diagnosed with schizophrenia that participate in clinical research trials. Findings indicate overall positive research experiences, with motivations aligning with previous research when it comes to trial participation including: altruism, personal benefit, access to medications, financial incentives, and psychosocial treatment. Learning about their illness and themselves, autonomy, and debriefing were also particularly important within this group. Unique to this sample were findings of friendship. Trust in the research staff was identified as a major underlying value and shaping factor impacting informed consent decisions. These conclusions have implications for recruitment and informed consent practices at InSite Clinical Research.
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Chun, Wai Kwong. "Voice hearing among Chinese people with schizophrenia in Hong Kong." HKBU Institutional Repository, 2009. http://repository.hkbu.edu.hk/etd_ra/985.
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Conner, Dianna Holden. "Social skills training for individuals with schizophrenia: Evaluation of treatment outcome and acquisition of social and cognitive skills." Thesis, University of North Texas, 2004. https://digital.library.unt.edu/ark:/67531/metadc4713/.
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Social and cognitive skill acquisition were evaluated in 33 (male=24, female=11) outpatients with schizophrenia or schizoaffective disorder. A social skills training treatment group (n=19) was compared to a wait-list control (n=14). Participants' mean age was 41 years, mean number of hospitalizations 10.4, and mean number of years with diagnosis 15.8. Assessment measures included WAIS-III Picture Arrangement subtest, Social Cue Recognition Test, COGLAB, WMS-III Word List subtest, and SADS-C. Results did not support the main hypotheses of improved social and cognitive skills in the treatment group. Participants with better memory and attention at pre-testing also did not show an advantage in social skills improvement. Contrary to hypotheses, the control group improved the most on some social and cognitive measures. Several supplemental hypotheses yielded the following results: lack of volunteer participation from paranoid schizophrenia individuals; evidence that schizoaffective disorder participants may be less cognitively impaired and better able to benefit from social skills training; and younger, less chronic participants with better attentional capacities may benefit most from social skills training. Findings are discussed in light of the possibility that improving social skills might not improve social and cognitive functioning, at least with the dosage of social skills training provided in this study. Limitations such as a sampling bias and small study size are also considered as possible explanations for the pattern of findings. Clinical and research implications are discussed to apply and extend the current findings.
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Theron, Janina. "Pragmatic assessment of schizophrenic bilinguals' L1 and L2 use : a comparison of three assessment tools." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/1783.
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Thesis (MPhil (General Linguistics))—University of Stellenbosch, 2009.ENGLISH ABSTRACT: The term "schizophrenia" refers to a psychiatric condition which affects an individual's thought and speech (Eaton and Chen 2006). The verbal expression of schizophrenics can therefore be used as a tool for insight into the nature of schizophrenia as well as the cognitive processes of schizophrenics (Wróbel 1990:1). This thesis reports on a comparative evaluation of three pragmatic assessment tools, namely the Pragmatic Protocol (Prutting and Kirchner 1987), the Profile of Communicative Appropriateness (Penn 1985), and the Framework for Assessing (Children's) Conversational Skills (Rumble 1988), in order to establish which of these tools is most suitable for assessing the first language (L1) and second language (L2) pragmatic abilities of late bilingual schizophrenics. Four late bilingual schizophrenic patients participated in this study. A thirty minute informal interview was conducted with each of the participants in both their L1 and L2 and the speech samples were transcribed and then analysed by means of each of the pragmatic assessment tools. A careful examination of the results yielded by the three assessment tools, showed, firstly, that when presenting the results of a pragmatic assessment of schizophrenic speech, it is crucial that both quantitative and qualitative information be included: if the latter is excluded, a significant amount of information is hidden from the clinicians and/or linguists doing the assessment, as well as the people to whom they report their findings. Secondly, with respect to the characteristics of schizophrenic speech, the three instruments used in this study show that whereas most of the aspects of schizophrenics' linguistic abilities seem intact, their pragmatic skills are definitely impaired. Thirdly, regarding differential symptomatology in bilingual schizophrenics, this study concludes that none of the three assessment tools contributes to a better understanding of this phenomenon, and that, in fact, it is highly unlikely that any pragmatic assessment tool would be able to capture this phenomenon. Finally, it is recommended that clinicians assess bilingual patients in both languages, whenever possible, in order to determine the full range of symptoms experienced by the patient, to gain a better indication of the severity of the illness and to track the progress of the illness.
AFRIKAANS OPSOMMING: Die term "skisofrenie" verwys na 'n psigiatriese toestand wat 'n individu se denkprosesse en spraak beïnvloed (Eaton en Chen 2006). Die verbale uitinge van skisofrene kan dus gebruik word om insig oor die aard van skisofrenie, sowel as die kognitiewe prosesse van skisofrene, te verkry (Wróbel 1990:1). Hierdie tesis lewer verslag oor 'n vergelykende evaluering van drie pragmatiese assesseringsinstrumente, naamlik die "Pragmatic Protocol" (Prutting en Kirchner 1987), die "Profile of Communicative Appropriateness" (Penn 1985), en die "Framework for Assessing (Children's) Conversational Skills" (Rumble 1988), om sodoende vas te stel watter een van hierdie drie die mees gepaste instrument is vir die assessering van tweetalige skisofrene se pragmatiese vaardighede in hul eerstetaal (T1) en tweedetaal (T2), spesifiek in gevalle waar die T2 later (d.w.s. nie binne die eerste sewe lewensjare nie) verwerf is. Vier sulke tweetalige skisofrene het deelgeneem aan die studie. Daar is met elkeen van die deelnemers 'n informele onderhoud gevoer vir 30 minute in hul T1, gevolg deur 30 minute in hul T2. Die onderhoude is getranskribeer en daarna geanaliseer deur middel van elk van die drie assesseringsinstrumente. 'n Noukeurige ondersoek en vergelyking van die resultate van die drie instrumente het eerstens getoon dat dit belangrik is om die resultate van 'n pragmatiese analise van skisofreniese spraak op beide 'n kwantitatiewe en kwalitatiewe wyse aan te bied: wanneer kwalitatiewe inligting weggelaat word, bly 'n betekenisvolle hoeveelheid van die informasie verborge vir die klinici en/of taalwetenskaplikes wat die assessering doen, asook die mense aan wie hulle hulle bevindinge rapporteer. Tweedens, met betrekking tot die eienskappe van skisofreniese spraak, wys die drie instrumente wat in hierdie studie gebruik is dat alhoewel meeste aspekte van skisofrene se taalvaardighede ongeskonde is, hulle pragmatiese vaardighede ooglopend aangetas is. Derdens, rakende differensiële simptomatologie in tweetalige skisofrene kom hierdie studie tot die gevolgtrekking dat geen van die drie instrumente bydra tot 'n beter begrip van hierdie verskynsel nie, en dat dit selfs hoogs onwaarskynlik is dat enige pragmatiese assesseringsinstrument hierdie verskynsel sou kon vaslê. Uiteindelik word daar aanbeveel dat klinici, wanneer dit ookal moontlik is, tweetalige pasiënte in beide tale behoort te assesseer om sodoende die volledige reeks van simptome wat 'n pasiënt ervaar vas te stel, om 'n beter aanduiding te bekom oor die erns van die siekte, en om die progressie van die siekte te volg.
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Steinberg, Marc L. 1971. "Engaging smokers with schizophrenia in treatment for tobacco dependence [electronic resource] : a brief motivational interviewing intervention / by Marc L. Steinberg." University of South Florida, 2003. http://purl.fcla.edu/fcla/etd/SFE0000075.
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Includes vita.Title from PDF of title page.
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Thesis (Ph.D.)--University of South Florida, 2003.
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Text (Electronic thesis) in PDF format.
ABSTRACT: The purpose of this study was to determine how to best motivate smokers with schizophrenia or schizoaffective disorder to seek treatment for tobacco dependence. Smokers with schizophrenia or schizoaffective disorder (N=78) were randomly assigned to receive a Motivational Interviewing, Psychoeducational, or Minimal Control intervention. A greater proportion of participants receiving the Motivational Interviewing intervention followed through on a referral for tobacco dependence treatment within one-week and one-month post-intervention. Mixed model Analyses of Variance found no differences between groups at one-week or at one-month with respect to tobacco use or motivation to quit. Within group analyses indicated that participants in the Motivational Interviewing and Psychoeducational groups reported significant decreases in cigarettes smoked per day.
ABSTRACT: Only participants in the Motivational Interviewing group showed significant increases in confidence in their ability to quit smoking.
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Mode of access: World Wide Web.
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Wills, Jack Blanton. "Effects of stress management instruction and anxiety monitoring in adult day treatment population." PDXScholar, 1986. https://pdxscholar.library.pdx.edu/open_access_etds/3698.
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This study examines the effectiveness of a particular stress management intervention with adult outpatients diagnosed as chronic schizophrenics. The setting for the study was the Portland, Oregon, Veteran's Administration, Outpatient Clinic, Day Treatment Center. The intervention was composed of two factors; 1) stress management training and 2) Behavior-Graph Instruction. Both of these were presented using a psychoeducational model of classroom instruction, role play, and discussion.
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Eichelberger, James R. "A Christian counselor's experience in working with schizophrenics in the state hospital system and preliminary treatment suggestions." Theological Research Exchange Network (TREN), 2005. http://www.tren.com.
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Wessels, Margaretha J. "The role of the clinical social worker in a treatment and rehabilitation programme for schizophrenic patients and their families." Master's thesis, University of Cape Town, 1988. http://hdl.handle.net/11427/17161.
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Bibliography: pages 181-192.Continued study towards understanding schizophrenia and the impairments it can cause, is regarded as essential in the meaningful fulfilment of the educative and diagnostic contributions which the social worker can make in a comprehensive treatment and rehabilitation programme (involving patients and their families). The first section of this descriptive dissertation focuses on aspects like terminology, definition, and the most recent diagnostic criteria, in an endeavour to contribute theoretically towards understanding the illness. The complexity of the diagnostic process is emphasized, and the recent revision of the criteria (1987) is seen as indicative of continuous efforts towards improved diagnosis, treatment and rehabilitation. Previous studies, improved pharmacology and more sophisticated neurophysiological examining led to a change in focus with regard to aetiology and the development of the vulnerability-stress-coping-competence model which brought new hope with regard to outcome of treatment. Section Two highlights several interventions which the clinical social worker can undertake as psychotherapist, group and family therapist, as well as educator on primary, secondary and tertiary levels, from this model and within the psycho-educative perspective. The Neuro B programme, Stikland Hospital, Bellville, is described in section Three, as an example of a presently operating, comprehensive programme where these interventions can be holistically implemented. Particulars about 56 patients who have been involved in the programme are highlighted in Section Four, while Section Five deals with the opinions of former patients and their families concerning involvement in the programme - elicited by two sets of questionnaires. The final chapter focuses on a summary of the dissertation, conclusions and implications for practice.
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Steinberg, Marc L. "Engaging Smokers with Schizophrenia in Treatment for Tobacco Dependence: A Brief Motivational Interviewing Intervention." [Tampa, Fla. : s.n.], 2003. http://purl.fcla.edu/fcla/etd/SFE0000075.
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Steuber, Lucas Carl. "Disordered Thought, Disordered Language: A corpus-based description of the speech of individuals undergoing treatment for schizophrenia." PDXScholar, 2011. https://pdxscholar.library.pdx.edu/open_access_etds/63.
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The characteristics of patient speech are used in clinical settings to make assumptions about the thought processes of people with psychotic disorders such as schizophrenia. However, there have not been any studies of the language of people with schizophrenia that present evidence drawn from a large group of speakers. This study employs a combination of quantitative and qualitative methods to determine whether 140 medicated individuals diagnosed with schizophrenia exhibit the linguistic abnormalities claimed in the literature. It also compares the speech of people with schizophrenia with that of people diagnosed with depression in order to assess whether there is a statistically significant difference in presence and/or frequency of abnormal speech between the two groups. Ultimately this study finds that all of the specific types of abnormal language behavior described in the literature do occur among a large group of individuals with schizophrenia. However, many such behaviors also occur among individuals with depression; there was a significant difference between the two groups for three of the twelve categories of language features assessed in this study, which were peculiar word choice, illogicality and distractibility. Further characteristics of the language of individuals with schizophrenia were also found, which could be a basis for improving clinical diagnostic materials.
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Windell, Deborah L. "Treatment and recovery in first-episode psychosis : a qualitative analysis of client experiences." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=100177.
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Background: There is currently very little research on recovery from the perspective ofindividuals with recent-onset of psychotic disorders. Forming a better understanding ofthesubjective meaning ofrecovery and recovery experiences during this early phase ofrecovery caninform effective and meaningful service design and practices.Method: Thirty individuals recovering from psychosis and receiving specialized earlyinterventiontreatment were interviewed regarding the meaning and experience of recovery frompsychosis during the early phase (2-5 years) ofthe illness course.Results: Recovery was described as a multidimensional experience that included aspects of"illness recovery," "psychological recovery," and "social recovery." Seven common earlyrecovery experiences were identified. Individual variations in the magnitude ofdescribeddisruption of self and social functioning, duration ofthe illness-acceptance process and theprocess treatment negotiation greatly influenced the experience ofrecovery.Conclusion: Differences in illness acceptance and social recovery trajectories have importantimplications for understanding individual responses to the experience ofpsychosis, its diagnosisand treatment. These differences emphasize the importance of assisting individuals with theconstruction of meaning and the reengagement in social roles following the initial illnessexperience.Contexte: Il y a actuellement peu de recherche sur la rétablissement du point de vue d'individusaprès un premier épisode de psychose. La formation d'une meilleure compréhension de senssubjectif des expériences de rétablissement pendant cette première phase de rétablissement peutinformer le design efficace et expressif des services et des pratiques.Méthode: Trente individus se rétablissement de la psychose et recevant un traitement depremière intervention spécialisé ont été interviewés à propos du sens et de l'expérience derétablissement de la psychose pendant la première phase (2-5 ans) du cours de maladie.Résultats: La rétablissement a été décrite comme une expérience multidimensionnelle qui ainclus des aspects de "la rétablissement de maladie," "la rétablissement psychologique," et "larétablissement sociale." Identifiées ont été sept premières expériences de rétablissementcommunes. Les variations individuelles dans l'étendue de perturbation décrite de soi et defonctionnement social, la durée du processus d'acceptation de maladie et de la négociation duprocessus de traitement ont beaucoup influencé l'expérience de rétablissement.Conclusions : Les différences dans les trajectoires d'acceptation de maladie et de rétablissementsociale ont des implications importantes pour comprendre les réponses individuelles àl'expérience de psychose, sa diagnose et traitement. Ces différences accentuent l'importanced'assister les individus avec la construction de sens et avec le réengagement dans les rôlessociaux après l'expérience de maladie initiale.
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Truter, Erika. "Genetic association analysis of polymorphisms in four cytochrome P450 genes, the MDR1 gene and treatment-outcome in Xhosa schizophrenia patients." Thesis, Link to online version, 2007. http://hdl.handle.net/10019/350.
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Walla, Berit. "Family perspectives in treatment of schizophrenia." Thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for sosialt arbeid og helsevitenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-12268.
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1. Changes in the role of relatives in different perspectives of schizophrenia – From causes to resources Purpose: The current paper aims to describe the last century changes in the relatives’ role in treatment of individuals with schizophrenia in medical, psychological, social, and research perspective. Methods: A literature review was obtained by searches on Bibsys, Helsebiblioteket, ISI web of Science, and PubMed. Key words were schizophrenia, psychosis, psychiatric history, caregiver burden, family intervention. Evidence based literature was obtained via searches of ISI Web of Science, EBCON, Pubmed, and Google Scholar computerized databases from 1960 through November 2008. Reports of earlier reviews of literature and original research were included. Conclusions: From being assumed as a cause of mental illness, to influence course and relapse, and now to be an important resource of the treatment and recovery of the patient, the relatives now are also recognized as caregivers with their own needs for help and support. There are still challenges to include evidence-based treatment in the clinical settings.2. Impact of a psychoeducative intervention on caregiver burden Objective: intervention on negative appraisal of caregiving experience, positive appraisal of caregiving experience, and health and functioning in relatives of patients with psychotic disorders compared to a waiting list control. Methods: Family members (N=68) of patients with psychosis received a six-session (a total of 15 hours), multi-family format psychoeducative intervention, - and completed an Experience of Caregiving Inventory (ECI) and COOP/WONCA (CW), which is a self reporting measure of the general state of health and functioning at the beginning, and at the end of the intervention. Those who went directly to the intervention (N=36) was used as intervention group and those who had to be on a waiting list (N=32) was used as a control group. Results: The study revealed significant differences between the psychoeducative intervention group on the ECI subcategory “problems with services” after the intervention period compared to the change in the control group (reduction mean -0.10v. 2.36; P= 0.043, effect size 0.062). There were no significant differences at the ECI total negative, the ECI positive subcategories, or on the C/W. Conclusion: The findings in this study suggest that psychoeducational intervention have reduced the relatives’ negative appraisal of the mental health services, but not increased the positive appraisals of experiences or the health and functional level.
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Wiker, Charlotte. "Novel pharmacological treatment alternatives for schizophrenia /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-343-6/.
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Gumley, Andrew Ian. "Psychological aspects of relapse in schizophrenia." Thesis, University of Stirling, 2002. http://hdl.handle.net/1893/12115.
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Following a review of the relevant literature a Cognitive Behavioural treatment protocol for the prevention of relapse in schizophrenia is presented. This treatment protocol is investigated in a 12-month non-blind randomised controlled trial comparing Cognitive Behavioural Therapy and Treatment as Usual (CBT + TAU) versus Treatment as Usual (TAU) alone. Three studies of treatment outcome are described: relapse and admission, remission and social functioning, and psychological distress. 144 participants with a DSM-IV Schizophrenia spectrum disorder were randomised to receive either CBT + TAU (n = 72) or TAU alone (n = 72). 11 participants dropped out (6 from CBT + TAU, 5 from TAU alone) leaving a completers sample of 133. Participants were assessed at entry, 12-weeks, 26-weeks, and 52 weeks. CBT was delivered over two stages: a 5-session engagement phase which was provided between entry and 12-weeks, and a targeted CBT phase which was delivered on the appearance of early signs of relapse. Over 12-months CBT + TAU was associated with significant reductions in relapse and admission rate. The clinical significance of the reduced relapse and admission rate amongst the CBT + TAU group was investigated. First, receipt of CBT + TAU was associated with improved rates of remission over 12-months. Second, clinically significant improvements in social functioning were investigated. Again, receipt of CBT + TAU was associated with clinically significant improvements in prosocial activities. However, receipt of CBT + TAU was not associated with improvements in psychological distress over 12-months. The theory underpinning the cognitive behavioural treatment protocol predicted that negative appraisals of self and psychosis represent a cognitive vulnerability to relapse. This hypothesis was investigated during the present 2 Abstract study. After controlling for clinical, treatment and demographic variables, negative appraisals of self and entrapment in psychosis were associated with increased vulnerability to relapse, whilst negative appraisals of self were associated with reduced duration to relapse. Finally, an explorative study of changes in negative appraisals of psychosis and self over time, which were associated with relapsers versus non-relapsers from the TAU alone group, was conducted. This study found a strong association between the experience of relapse, increasing negative appraisals of psychosis and self, and the development of psychological co-morbidity in schizophrenia. Results of treatment outcome and theoretical analyses are discussed in terms of their relevance to the further development of psychological models and treatments for psychosis.
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Smith, Michelle. "The role of Lorikeet Clubhouse in psychiatric rehabilitation." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2001. https://ro.ecu.edu.au/theses/1063.
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Previous studies have suggested that participation in psychosocial support groups such as the Foundation House (Clubhouse) model have psychological benefits for patients with major mental disorders. In this research, 47 members of the Lorikeet Clubhouse in Shenton Park, WA completed the Brief Symptom Inventory, the Level of Expressed Emotion Scale and the Coping Scale for Adults to investigate whether differences existed between active and inactive Clubhouse members. Analyses of variance found no group differences on these measures, although trends in the data suggest that Clubhouse participation have a protective effect for members who report high levels of expressed emotion (EE) in their home. These conclusions are tentative due to the small sample size. Members perceived the Clubhouse to have lower levels of EE than their home environments, however these measures were correlated.
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Matthiasson, Páll. "Dealing with treatment resistance to clozapine : characteristics of treatment response in schizophrenia." Thesis, King's College London (University of London), 2006. https://kclpure.kcl.ac.uk/portal/en/theses/dealing-with-treatment-resistance-to-clozapine--characteristics-of-treatment-response-in-schizophrenia(f43c968b-8789-44e7-9161-3cab811ee429).html.
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Background: Clozapine, the treatment of choice in treatment-resistant schizophrenia, is not effective in up to half of patients. Aims of this thesis were: to verify whether clozapine augmentation with amisulpride, an atypical antipsychotic with preferential affinity at doparninergic D2-like receptors, is clinically effective; to test the prediction that changes in D2-like receptor availability might explain that improvement; to explore clinical and receptor availability characteristics of good clozapine responders. Methods: Study 1: Thirty-three patients with schizophrenia, partially or non-responsive to clozapine, had augmentation with amisulpride using an open label design. Study 2: Ten patients recruited from study 1 underwent 123I_IBZM SPET scans at baseline and after 10-12 weeks on amisulpride augmentation, to assess striatal D2-like receptor binding potential. Ten matched controls had one 123I-IBZM scan. Scanning was carried out using a Picker Prism 3000XP triple headed SPET camera. Study 3: Ten "good" responders to clozapine monotherapy were matched to patients in study 2 and had one 123I-IBZM scan. Results: Study 1: Twenty-eight subjects (85%) completed 6 months' augmentation. There was a statistically significant improvement from baseline in clinical rating scales and no change in side-effects. 71% and 32% of patients showed a 20% and 50% reduction in BPRS respectively. Study 2: Patients had mean striatal D2-like receptor occupancy of 47% at baseline, which increased with amisulpride augmentation to 59%. Study 3: Clozapine responders were on much lower doses of clozapine (331 mg/day) with lower s-clozapine levels (0.26 ng/L). Their D2-like occupancy was 45%. Conclusion: The augmentation led to substantial improvement in both positive and negative symptoms and was well tolerated. It raised D2-like binding to likely "threshold levels" for response. Some patients require both the broad receptor occupancy profile of clozapine and a higher degree of D2-like receptor occupancy than can be provided by clozapine alone.
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Tuninger, Eva. "Depot neuroleptic maintenance treatment clinical, pharmacological and neuropsychological aspects /." Lund : Dept. of Psychiatry, Lund University, University Hospital MAS, 1997. http://catalog.hathitrust.org/api/volumes/oclc/40281424.html.
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Demjaha, Arsime. "Biological and clinical determinants of treatment resistant schizophrenia." Thesis, King's College London (University of London), 2014. https://kclpure.kcl.ac.uk/portal/en/theses/biological-and-clinical-determinants-of-treatment-resistant-schizophrenia(eeabcaab-e9c7-4d41-99e6-8428569f57d0).html.
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Up to one third of patients with schizophrenia show only limited response to dopamine blocking antipsychotic medication. This could be due to distinct neurobiological abnormalities in this subgroup of patients. While there is robust evidence to suggest that the neurobiology of schizophrenia involves increased presynaptic striatal dopaminergic elevation, little is known as to whether this abnormality is present in treatment resistance, and consequently the relationship between this dopamine abnormality and the lack of response to treatment remains unknown. Furthermore, it remains unclear whether treatment resistance manifests at the outset of illness, and perhaps has a neurodevelopmental origin, or whether it evolves over time, possibly as a result of a neurodegenerative process. The first study in this thesis investigated striatal presynaptic dopamine synthesis in twelve treatment resistant schizophrenic patients, twelve patients with schizophrenia who had responded to antipsychotics, and twelve healthy volunteers, using [18F]-DOPA Positron Emission Tomography (PET). Thus, it was possible to test the hypothesis that the response to treatment is determined by differences in presynaptic dopamine function. The results demonstrated that there were no significant differences in striatal dopamine synthesis capacity between treatment resistant patients and healthy volunteers, whilst dopamine synthesis capacity was significantly increased in responders relative to treatment resistant patients. The difference was most marked in the associative and the limbic striatal subdivisions. A second, large follow-up study of first episode psychosis (FEP) patients, examined the course of treatment resistance over the 10 year follow up. It was found that over 80% of treatment resistant patients were persistently resistant from the initiation of antipsychotic treatment. My PET study, due to its cross sectional design, could not determine whether the normal dopamine levels predate the antipsychotic exposure in treatment resistant patients. However, by demonstrating that a great majority of treatment resistant patients are resistant to dopamine blocking antipsychotics at first ever initiation of treatment, my second study raises the possibility that these patients may have had normal dopamine levels even at the outset of their psychotic illness. In the same FEP cohort it was possible to investigate neurodevelopmental predictors of treatment resistance. The finding that the negative symptom dimension and younger age of onset were significant predictors of treatment resistance is compatible with the view that TRS may be of neurodevelopmental origin. Overall, my observations in this thesis indicate that TRS may be a distinct and enduring subtype of schizophrenic illness of a possible neurodevelopmental origin whose pathophysiology is not marked by alterations in dopamine synthesis capacity. Findings emerging from this thesis provide a platform for future studies, which may lead to the discovery of much needed new treatments for this disabling and intractable condition.
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Haddock, Gillian. "Auditory hallucinations : cognitive processes, phenomenology and psychological treatment." Thesis, University of Liverpool, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.240522.
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Davis, Kimberly Ann. "Best practices for the treatment and management of schizophrenia /." Full-text of dissertation on the Internet (319.70 KB), 2010. http://www.lib.jmu.edu/general/etd/2010/masters/davis3ka/davis3ka_masters_04-21-2010_01.pdf.
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Alladin, Waseem Jamal. "Social dysfunction in chronic schizophrenia : nature, treatment and generalization." Thesis, University of Hull, 2005. http://hydra.hull.ac.uk/resources/hull:5633.
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The present research explores the impact of neurocognitive status on generalization of social skills training and how these difficulties are further compounded by the difficulty of inadequate matching of problems to treatments. The generalization problem is addressed in two phases. In the first phase, a suggestion that a subgroup of chronic schizophrenia patients may have normal abstract problem solving was investigated by comparing paranoid and non-paranoid chronic schizophrenic in-patients (n= 11 per group) with assessed social dysfunction. Only the paranoid group had profiles comparable to matched normal controls. The non-paranoid group had neuropsychological deficits (executive dysfunction) on the Wisconsin Card Sorting Test (WCST). In the second phase, a longitudinal study compared the differential efficacy of behavioural versus cognitive-behavioural social skills training (SST), and monitored the effects on maintenance and generalization, focusing on social anxiety. Concurrently, the treatment validity of a multidimensional assessment of social problem solving was assessed using an alternating treatments design with a multiple baseline across participants from three groups: skill deficits (n=3), cognitive blocks (n=3) and a control group (n=3) with both problems. All participants received four randomized sessions each of Behavioural SST and Cognitive-Behavioural SST. The group SST used a 'whisper in the ear' game format and included self-instructional training and social problem solving to facilitate generalization. The findings demonstrated the treatment validity of the multidimensional assessment and offered preliminary evidence for the differential efficacy, maintenance and generalization of Behavioural and Cognitive-Behavioural SST which occurred for untrained behaviours and was maintained at the 3- and 9-month follow-ups but only for those not impaired on the WCST. It is concluded that it is more productive for assessmentto focus on social anxiety and the practice of mixing schizophrenia patients in SST, without taking a neurocogitive baseline, may be responsible for confounding generalization efforts. A limitation of the research is that gender differences were not testable as there were insufficient numbers.
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Joubert, Andre Francois. "Implementation of international treatment guidelines in the treatment of schizophrenia : a study of the effects of an evidence-based seminar on the knowledge and treatment habits of a sample of international psychiatrists." Thesis, Stellenbosch : University of Stellenbosch, 2007. http://hdl.handle.net/10019.1/1322.
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Thesis (DMed (Psychiatry))--University of Stellenbosch, 2007.This study reports on the effect of seminar education by studying changes in knowledge, attitude and behaviour to haloperidol prescribing patterns of psychiatrists who In summary, this study demonstrated a direct relationship between seminar attendance and changes to selected minimum effective haloperidol dose and duration of treatment. However, seminar attendance did not appear to be a significant factor in changes to antipsychotic class used for treatment and changes in optimal effective haloperidol dose: rather a change in the level of “background” knowledge of participants was most likely responsible. This study also found individual participant characteristic differences in those who did change treatment duration and minimum effective dose. In conclusion, this study showed that the successful integration of international treatment recommendations into daily psychiatric practise could be facilitated by the use of appropriate educational seminars. Not all attendees benefit i.e. “learn”, but those needing to “learn” most do - i.e. those who need to change their prescribing habits most to meet internationally accepted guidelines. The peer exposure provided allows a format for informed discussion and the practise of evidence-based medicine. The judicious use of such seminars should result in better treatment options and outcomes for patients.attended evidence-based schizophrenia seminars presented by the Lundbeck Institute in Denmark. The objectives of the study were two-fold. Firstly, it set out to determine whether changes actually occurred in the post-seminar haloperidol prescribing behaviour of participants. This was done by analysing changes in choice of optimal haloperidol dose (both in acute treatment i.e. most effective dose and maintenance treatment i.e. minimum effective dose), selected duration of treatment (for first- and multi-episode schizophrenia patients) and drug-class used (conventional versus new generation antipsychotic). The study then investigated whether these changes (if they occurred) could be ascribed wholly or in part to the effect of schizophrenia seminar attendance, or whether other factors e.g. scientific progress over time in understanding schizophrenia and its treatment (“background” knowledge) and differences between participant datasets studied (only paired pre- and post-seminar data were used in this study) also played a role. Secondly, it attempted to identify factors predictive of seminar participants changing their haloperidol prescribing behaviour post-seminar i.e. what were the factors that predisposed some attendees to change their prescribing behaviour? This was done by analysing the effect that pre-seminar prescribing behaviour, participant nationality, patient caseload, work experience and workplace environment had on post-seminar behaviour. Results show that changes did occur in post-seminar haloperidol prescribing behaviour, but that they were not always due to an effect of seminar attendance. Only the changes in the minimum effective haloperidol dose and duration of treatment for first- and multi-episode schizophrenia patients could validly be ascribed to the effects of schizophrenia seminar attendance. Furthermore, multivariate analysis of the factors relating to these changes found that a participant was most likely to change their selected minimum effective haloperidol dose to be more in line with internationally accepted standards if they i) selected above the target dose pre-seminar, ii) had a relatively low caseload comprised mainly of schizophrenia patients and iii) came from either Greece, Germany, Britain, Spain, Italy or some other Eastern European country. The single most important factor related to changes in duration of treatment was found to be pre-seminar behaviour: respondents below the recommended duration of treatment increased their duration of treatment significantly.
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Leung, Mei-kei. "MRI brain abnormality in first episode schizophrenia before and after treatment." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43572303.
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Deng, Yi, and 鄧藝. "From neuroimaging to proteomics in schizophrenia." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43278516.
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Duarte, Eugenio A. "General Religiosity and Use of Religious Coping as Predictors of Treatment Gains for Patients with Schizophrenia and Their Relatives." Scholarly Repository, 2009. http://scholarlyrepository.miami.edu/oa_dissertations/299.
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While research on religion and severe psychopathology is mixed, the majority of evidence suggests that greater religiosity and greater use of religious forms of coping relate to beneficial psychosocial outcomes for both patients with schizophrenia (Huguelet et al., 2006; Moss et al., 2006) and their family members (Pearce et al., 2006; Roff et al., 2004). However, this data is generally cross-sectional. To date, scant research has longitudinally examined how religious beliefs and practices relate to key indicators of psychosocial outcomes for patients with schizophrenia and their relatives. This study used a White and Hispanic sample of 41 patients with schizophrenia and 57 relatives of such patients to examine cross-sectional and longitudinal links between religion and mental health. Results showed that increases in the use of religious forms of coping over time significantly predicted decreases in emotional distress for family members. Results also supported the hypothesis that greater positive and lessor negative forms of religious coping would relate to beneficial outcomes for patients and family members. Lastly, this study found that, for patients, ethnicity appeared to moderate the link between religiosity and outcome. Findings from this study highlight the importance of religion to patients and caregivers coping with schizophrenia. Clinicians treating patients with schizophrenia and their loved ones are cautiously encouraged to explore religion with their clients, with particular attention to its differential influence among patients versus relatives and among Whites versus Hispanics.
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Thacker, Stephanie K. "Chronic Olanzapine Treatment Eliminates Cognitive Deficits Produced by Neonatal Quinpirole Treatment." Digital Commons @ East Tennessee State University, 2005. https://dc.etsu.edu/etd/1011.
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This study evaluated the effects of chronic olanzapine treatment on cognitive performance and neurochemical function in a rodent model of schizophrenia. Animals were neonatally treated with quinpirole, a dopamine D2 receptor agonist, or saline. Quinpirole treatment produces an increase of dopamine D2 receptor sensitivity that extends into adulthood, known as D2 receptor priming, similar to a phenomenon that occurs in schizophrenia. These same rats were treated in adulthood for 28 days with olanzapine, an atypical antipsychotic, or saline. Dopamine D2- primed rats demonstrated significant deficits on a cognitive task that were alleviated by olanzapine treatment. Brain tissue analysis revealed that D2-primed animals demonstrated a significant decrease in the neurotrophins nerve growth factor (NGF) in the hippocampus and brain-derived neurotrophic factor (BDNF) in the frontal cortex. Olanzapine treatment alleviated the decrease in NGF. The results suggest that olanzapine eliminates cognitive impairment and may have neuroprotective properties in the hippocampus of D2-primed rats.
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Mojtabai, Ramin. "Psychosocial treatments for schizophrenia : meta-analytic review of controlled outcome studies /." Access abstract and link to full text, 1995. http://0-wwwlib.umi.com.library.utulsa.edu/dissertations/fullcit/9635176.
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Eltayb, Amani. "Experimental studies on novel pharmacological strategies in the treatment of schizophrenia /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-575-5/.
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Holowka, Darren W. "Explaining treatment response in Schizophrenia : integration of genetic and environmental factors." Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=78380.
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Response to antipsychotic (AP) medication is critical to predicting long-term outcome in schizophrenia. This study examined the relationship between treatment response (TR) and four risk factors for schizophrenia. Method. Twenty-six outpatients were interviewed to assess childhood trauma and substance use. Patients' mothers completed interviews concerning family history of schizophrenia spectrum disorders and obstetric complications. TR was evaluated through information gleaned from medical records. Results. Family history of schizophrenia spectrum disorders (FH) was associated with decreased response to typical APs (r = -.37, p < .05). More severe childhood trauma was associated with worse TR (r = -.51, p < .001) while premorbid LSD use was associated with better TR (r = .52, p < .01). Further examination revealed that FH moderated the effects of trauma and LSD use on response to typical APs. None of the putative risk factors explained variance in TR to atypical APs. Conclusion. Childhood trauma and premorbid LSD use may cause permanent neurochemical changes responsible for altered TR in some individuals.
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Leung, Mei-kei, and 梁美琪. "MRI brain abnormality in first episode schizophrenia before and after treatment." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43572303.
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Wahass, Saeed H. "A cross-cultural study of auditory hallucinations of schizophrenic patients: phenomenology and treatment." Thesis, University of Sheffield, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.483978.
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Munnik, James Barry. "Assessing the potential of submaximal extended duration exercise as an adjunct treatment for sub-acute schizophrenic in-patients : a pilot study /." Thesis, Rhodes University, 2006. http://eprints.ru.ac.za/889/.
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Li, Yiu-bun, and 李耀斌. "Comorbid obsessive-compulsive symptoms (OCSs) and obsessive-compulsive disorder (OCD) in patients with schizophrenia treated with clozapine or haloperidol." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/200383.
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Aims: A case-control study is done aiming(i)to explore the prevalence of OCSs and OCD among patients with Schizophrenia treated with Clozapine(Target group)in comparison with those treated with Haloperidol(Control group), (ii) to identify the associative factors in relationship with OCSs and OCD in Schizophrenia patients treated with Clozapine in comparison with Haloperidol , (iii)to find out predictors for the increase of OCSs and OCD among patients treated with Clozapine in comparison with Haloperidol. All these information may contribute to the understanding of the underlying etiology of OCSs and OCD.
Method: Sample is comprised with patients aged 18-65 who meet the diagnostic criteria of Schizophrenia-spectrum disorder based on ICD 10 and retrieval of medical records. A total of 120 patients, comprising 30 males and 30 females patients currently prescribed with Clozapine(Target group)whereas30 male and 30 female patients are currently prescribed with Haloperidol (Control group)were identified from the Schizophrenia outpatient clinic in the same hospital. Both groups will be matched with gender. Obsessive compulsive symptoms were measured with the Chinese version of Yale-Brown Obsessive-Compulsive Scale to rate the severity of the symptoms. The severity of Schizophrenia symptoms was rated by the Positive and Negative Syndrome Scale, and the Clinical Global Impression was used to measure severity symptoms in general. The social functioning of patient was rated by The Social and Occupational Functioning Assessment Scale(SOFAS). A clinical interview questionnaire was developed to determine the social and demographic characteristics, as well as other clinical features of the disorder. It included patient’s age, frequency of hospitalisation, age of onset and duration of Schizophrenia, age of onset and duration of OCSs and OCD and age of first hospitalisation, Duration of Untreated Psychosis (DUP) and current antipsychotic medication dosage( Chlorpromazine equivalent dose).
Results: From the 120 patients identified and approached, 96 (80%) patients (48 male and 48 female patients) were consented for the study. The current study found that among those prescribed with Clozapine (Target group), there were 26.5% comorbid with OCSs and OCD, whereas none patients reported OCSs and OCD among the Haloperidol Control group.
Patients with OCSs and OCD were significantly correlated with PANSS Positive Syndrome Score and PANSS Total Syndrome Score factors analysis by the N Par test of Mann-Whitney U, Wilcoxon W and Z score for Asymp.
Using correlations test analysis, the most significantly factors to OCSs and OCD are Clozapine (Target group), PANSS Positive Syndrome Score and PANSS Total Syndrome Score.
Result showed that those three factors cannot be the prediction of OCSs and OCD from the Binary logistic regression analysis.published_or_final_version
Psychological Medicine
Master
Master of Psychological Medicine
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Chiliza, Bonginkosi. "A prospective study of clinical, biological and functional aspects of outcome in first episode psychosis." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/97904.
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Thesis (PhD)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Prospective, longitudinal clinical studies in first-episode schizophrenia have become relatively commonplace over the past two decades or more and have provided a wealth of useful information regarding the clinical presentation, treatment, course and outcome of the illness. However, there remain several unanswered questions. The majority of the studies have been conducted in upper income countries using often costly medication with heterogeneous samples. While the overall outcome of patients showed some progress, there is room for improvement yet. The overall aim of the dissertation was to study the clinical, biological and functional aspects of outcome in first episode schizophrenia in a resource constrained setting. We conducted a prospective, non-comparative, longitudinal study over 12 months assessing the efficacy and tolerability of a cost effective, long-acting injectable antipsychotic (LAI; flupenthixol decanoate) combined with an assertive monitoring program (AMP) among first-episode schizophrenia patients. Efficacy was measured by examining rates of response, remission and relapse, as well as quality of life and social and occupational functioning. Tolerability of our intervention was assessed by measuring extrapyramidal symptoms, and weight and metabolic changes. We also examined the evolution of treatment refractoriness by studying the rates of non-response, and other associated predictor and outcome features. We found high rates of acceptance and adherence to the LAI and AMP. Seventy percent of our patients completed the 12 months of treatment. Treatment response was achieved by 82% of the participants and 60% achieved remission. Although 19% of our patients relapsed, the majority of the relapses were mild and did not require hospitalisation. Patients experienced significant quality of life and social and occupational functioning improvements. We found mild rates of extrapyramidal effects, present in only a third of our cohort. The majority of the extrapyramidal effects were treated with anticholinergics or propranolol. Only 3% of our patients developed transient dyskinesia over the duration of the study. However, our cohort gained considerable weight, with statistically significant increases in BMI (p< .0001) and waist circumference (p=0.0006). Our cohort also experienced significant deleterious changes to their lipid profiles. Of particular concern was the increase in triglycerides (p=0.03) and a significant decrease in high density lipoprotein (p=0.005) leading to a 91% increase in the triglyceride/high density lipoprotein ratio. With regards to emerging treatment refractoriness, 12% of our patients met our pre-defined criteria for non-response. Non-responders were younger and at baseline showed more prominent disorganised symptoms, poorer social and occupational functioning, poorer quality of life for psychological, social and environmental domains, more prominent neurological soft signs (NSS), and lower BMI. At endpoint the non-responders were characterised by higher levels of symptomatology in all domains; poorer functional outcome, poorer quality of life and greater cognitive impairments. They also had more prominent NSS and a lower BMI. The strongest predictors of non-response were prominent baseline NSS and poor early (7 weeks) treatment response. In conclusion, the combination of an LAI with an AMP may be an effective and safe intervention in firstepisode schizophrenia, and may be particularly suitable for resource-constrained settings. The risk of weight gain and metabolic syndrome associated with antipsychotic treatment in first-episode schizophrenia are not restricted to second generation antipsychotics and low-potency first-generation antipsychotics. Ensuring effective treatment for first episode schizophrenia patients is a global problem, and likely to be under-recognised in LMICs.
AFRIKAANSE OPSOMMING: Oor die afgelope twee dekades het toenemend meer longitudinale kliniese studies, wat eerste episode skisofrenie bestudeer, die lig gesien. Die studies het ‘n magdom van waardevolle inligtng oor die kliniese voorkoms, behandeling, verloop en uitkomste van die siekte opgelewer. Die meerderheid van die studies is egter in hoë inkomste ontwikkelde lande gedoen met pasiënte wat duur medikasie gebruik en hoofsaaklik in heterogene steekproewe. Alhoewel dit blyk uit hierdie studies dat daar oor die algemeen vordering gemaak word ten opsigte van die behandeling van pasiënte is daar steeds ‘n gebrek aan voldoende inligting oor die onderwerp veral in minder gegoede, ontwikkelende lande. Die oorhoofse doel van hierdie proefskrif is om binne ‘n hulpbron beperkte konteks die kliniese, biologiese en funksionele aspekte van pasiënt -uitkomste in eerste episode skisofrenie te ondersoek. Ons het ‘n longitudinale studie gedoen waarin ons die effektiwiteit en toleransie van ‘n enkele antipsigotiese medikasie vir 12 maande nagevors het. Die medikasie wat ons ondersoek het, is flupenthixol decanoate en word deur ‘n inspuiting gegee en die medikasie word dan geleidelik deur die liggaam geabsorbeer. As deel van die behandeling het ons pasiënte ook streng gemonitor. Ons het die effektiwiteit van die behandeling gemeet nagelang van hoe pasiënte reageer op die behandeling, hoeveel pasiënte in remissie gaan en terugval, en ook pasiënte se kwaliteit van lewe en hulle sosiale en beroepsfunksionering. Ons het toleransie gemeet nagelang van pasiënte se gewig en metaboliese verandering sowel as die voorkoms van medikasie geïnduseerde newe-effekte. Verder het ons pasiënte wat nie op medikasie gereageer het nie ondersoek sowel as die aspekte wat moontlik hiernee verband hou. Ons het bevind dat die meerderheid van pasiënte hulle medikasie getrou geneem het en ook die streng monitering aanvaar het. Sewentig persent van die pasiënte het hulle 12 maande behandeling voltooi, 82% het op die medikasie gereageer en 60% het in remissie ingegaan. Alhoewel 19% van die pasiënte teruggeval het, was dit nie so ernstig dat ons hulle moes hospitaliseer nie. Pasiënte het beduidende verbetering ten opsigte van hulle kwaliteit van lewe en sosiale en beroepsfunksionering getoon. Ons het slegs ‘n gematigde mate van medikasie geïnduseerde newe-effekte opgemerk en alleenlik by ‘n derde van die kohort. In die meerderheid van gevalle het ons die newe-effekte met anticholinergics of propranolol behandel. Slegs 3% van die pasiënte het gedurende die verloop van 12 maande die kondisie transient dyskinesia ontwikkel. Ongelukkig het ons kohort geweldig baie gewig opgetel en die toename in pasiënte se BMI (p< .0001) en middellyf omtrek (p=0.0006) was statisties beduidend. Ons het ook bevind dat veranderinge in ons kohort se lipied profiele kommerwekkend is veral as in ag geneem word dat die toename in trigliseriede (p = 0,03) en die beduidende afname in die hoë digtheid lipoproteïen (p = 0,005) gelei het tot ‘n 91% verhoging in trigliseriede: hoë digtheid lipoproteïen verhouding.
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Dunham, Radha Gaia. "Client Characteristics and Therapist Competence and Adherence to Family Therapy for Schizophrenia." Scholarly Repository, 2008. http://scholarlyrepository.miami.edu/oa_theses/113.
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The current study aims to clarify how therapist competence/adherence relates to client characteristics, consumer satisfaction, and dropout rates for family interventions for schizophrenia. The study was conducted as part of a larger treatment trial which will test the efficacy of a culturally informed therapy for schizophrenia (CIT-S), against a treatment as usual (TAU) comparison group. Encouragingly, overall, therapists were found to demonstrate very high levels of competence/adherence in both treatment conditions. As hypothesized, less severe psychiatric symptoms and lower ratings of family difficulty were related to greater therapist competence/ adherence in several non-specific (e.g., establishing rapport) and CIT-S specific (fostering family cohesion) domains of treatment. Also as hypothesized, certain aspects of greater competence/ adherence were related to lower dropout rates and higher consumer satisfaction. Contrary to expectations, general emotional distress and family cohesion were not related to competence/adherence. This study suggests that clinicians and clinical researchers may want to take certain client characteristics into account when evaluating therapist performance, choosing clients who are most suitable for therapy, and providing feedback to supervisees. Additionally, clinicians and researchers may want to monitor therapist performance early on in treatment in order to address issues which may impact consumer satisfaction and treatment retention.
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Smith, Philip. "Negative symptoms of schizophrenia and psychosocial treatment : thematic analysis of stakeholders' perspectives." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7589/.
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Objectives. Recent literature indicates variance in psychosocial treatment preferences for negative symptoms of schizophrenia. Attempts at defining therapeutic aims and outcomes for negative symptoms to date have not included major stakeholder groups. The aim of the present study was to address this gap through qualitative methods. Design. Thematic Analysis was applied to qualitative semi-structured interview data to gather the opinions of people who experience negative symptoms, carers, and healthcare professionals. Participants were recruited from two mental health sites (inpatient/community) to increase generalisability of results. Ten people participated in the research. Methods. Semi-structured interview scripts were designed utilising evidence from the review in Chapter 1 of effective psychosocial intervention components for specific negative symptoms. Interviews were audio recorded and transcribed verbatim. Thematic analysis was employed to analyse data. Results. A common theme across groups was the need for a personalised approach to intervention for negative symptoms. Other themes indicated different opinions in relation to treatment targets and the need for a sensitive and graded approach to all aspects of therapy. This approach needs to be supported across systemic levels of organisation with specific training needs for staff addressed. Conclusions. There is disparity in treatment preferences for negative symptoms across major stakeholders. The findings suggest an individualised approach to intervention of negative symptoms that is consistent with recovery. Implementation barriers and facilitators were identified and discussed. There remains a need to develop a better understanding of treatment preferences for patients.
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Milovan, Denise L. "Generation of mismatch negativity in a sample of treatment-resistant schizophrenia patients." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape15/PQDD_0022/MQ39943.pdf.
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Hayhurst, Karen P. "Non-evidence-based antipsychotic drug prescribing in the treatment of adult schizophrenia." Thesis, University of Manchester, 2009. http://www.manchester.ac.uk/escholar/uk-ac-man-scw:172552.
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Introduction. The extent of combination antipsychotic prescribing (CAP), or polypharmacy, in the treatment of schizophrenia is high, with evidence of prevalence exceeding 40% nationally and 30% across Greater Manchester. CAP increases the incidence of adverse drug events and inadvertent high dosage, whilst elevating treatment costs. Guidance against CAP is contained in both local and national evidence-based treatment guidelines. Few previous studies have attempted to alter this antipsychotic prescribing practice. The aims of the studies described here were to develop and evaluate an intervention to reduce rates of CAP in a mental health services catchment area in Greater Manchester, alongside an investigation of the main aspects of CAP: whether rates of CAP are as high as those recorded previously across the city; whether CAP is associated with other non-evidence-based antipsychotic prescribing; whether some patients are more likely to be treated with CAP than others; and what it is like, from the patient’s perspective, to take antipsychotic drugs, including those taken in combination. Methods. A series of studies was performed to inform the development of the intervention to reduce CAP rates. A systematic review of previous intervention studies to change prescribing habits was undertaken. A survey of current rates of CAP across Greater Manchester was also performed and CAP’s relationship to other non-evidence-based prescribing was assessed. Qualitative patient interviews and the measurement of clinicians’ prescribing attitudes were carried out. The database from a large clinical trial was also analysed to identify predictors of CAP. The resulting multifaceted intervention package comprised audit and feedback, the use of an opinion leader, individual educational visits and a reminder system. Its effectiveness in reducing rates of CAP was assessed in comparison to a parallel catchment area without the intervention. Results. The systematic review and meta-analysis suggested that interventions could change prescribing, with an overall reduction in the probability of CAP of 10% resulting from pooling data. Rates of CAP recorded across treatment settings in Manchester (between 14% and 22%) were lower than those recorded in national prescribing surveys. Most cases of high dose prescribing were secondary to CAP. High rates of CAP predicted low rates of clozapine prescribing but this association failed to reach statistical significance. Demographic and clinical characteristics (older age, longer illness duration, lower global functioning score and higher adherence rating) were associated with receipt of CAP. The intervention failed to reduce rates of CAP post-intervention, compared with pre-intervention, and with rates seen in a site where the intervention did not take place. Conclusions. The systematic literature review showed that behavioural and educational interventions can have modest effects on reducing CAP. The package developed here failed to reduce rates of CAP using a multifaceted prescribing intervention. Reasons for this may include lower than anticipated rates of CAP at baseline. More research is required to explore the role played by patient preference in the continuance of CAP and in clinicians’ prescribing behaviour.
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Thompson, Laura. ""So you feel a bit anxious?" : psychiatrist-patient communication and treatment adherence in schizophrenia." Thesis, Queen Mary, University of London, 2013. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8561.
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24 million people worldwide are affected by schizophrenia. Its complex psychopathology, including changes in perception, can incur substantial personal distress and economic burden. Finding appropriate treatment that attracts voluntary adherence is an ongoing challenge for clinicians to prevent relapse and poor prognosis. This thesis conceives the psychiatrist-patient alliance - mediated through talk - as an intervention point that demands analytic attention. Conceptualising ‘good’ communication is however hindered by a lack of a) conceptual clarity on its constituents b) knowledge of what actually happens in psychiatric encounters. Abstract ideals of ‘Patient Centredness’ and ‘Shared Decision Making’ are widely endorsed as beneficial to adherence, but do not pragmatically translate into specific practices, conducive to training. Following a preparatory systematic review, this thesis addresses a gap in literature by observing psychiatric communication in 3 mixed method studies. Synthesising coding methodologies and statistical analyses with principles of conversation analysis, two studies explore the association - and explanatory mechanism - between adherence and specific communication practices: patient other-initiated repair and psychiatrist questions. Treatment decisions, the precursor to adherent behaviour, are also examined: alternative resources that psychiatrists employ and their interactional consequences are mapped, with a focus on patients’ overt resistance. The findings collectively extend knowledge on medical interaction and demonstrate the utility of a novel approach to outcome research in field dominated by cross sectional studies. Clinical, methodological and theoretical contributions are yielded relating to six themes 1) the consequentiality of psychiatrists’ communicative choices 2) the manifestation of alliance and adherence in clinical talk 3) orientations to experiential expertise and the contingencies of antipsychotic medication adherence 4) reconceptualising ‘good’ communication: misalignment as key to clinical success 5) evidence of the interaction order in schizophrenia 6) reconciling the nuances of naturalistic interaction with global clinical outcomes.
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Mortimer, Ann M. "The neuropsychology of chronic severe schizophrenic patients treated with clozapine versus treatment as usual." Thesis, University of Leicester, 2003. http://hdl.handle.net/2381/29435.
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Introduction: The cognitive effects of antipsychotic drugs represent a potential exploratory tool with which to investigate theoretical models of schizophrenia. According to the `levels of explanation' model, the manipulation of cognition of drugs, reflecting prior changes in brain physiology, should result in symptomatic change. Clozapine is superior to other antipsychotic drugs in the treatment of the symptoms of schizophrenia, but there was little support for the proposition that this was because of superior improvements in cognition. This study aimed to investigate this question in severely ill patients with major cognitive deficits. Additionally since data collection commenced (1993) cognition had become established as the most important determinant of social function in schizophrenia. The methodology of the study allowed for a prospective appraisal of this tissue. Method: This was an open naturalistic study. 26 chronic schizophrenic long stay inpatients began clozapine or stayed on treatment as usual according to clinical decision. Symptoms, cognition (rated independently) and social function were comprehensively assessed at baseline, six months, one year and two years. Results: At baseline the groups were similar on most measures. Clinical response rates in the clozapine group were consistent with the literature, and were better than expected in the treatment as usual group. There were striking improvements in symptoms and social function on clozapine which overall appeared early into the two year period. By contrast, no aspects of cognition improved significantly on clozapine, although there were some between group differences which overall occurred later in the study. Comparing clinical responders with non-responders across both groups did not change the cognitive results. Analyses suggested that gains in personal function were related to negative symptoms, not to cognition. Conclusions: The `levels of explanation' model of schizophrenia was not supported. This is discussed in terms of the alternative `domains' model, and the possible impact of symptom severity on cognition in these patients. In conclusion symptomatic relief and control should remain, at least in severely ill schizophrenic patients, the primary focus of therapeutic effort.
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Rung, Johan. "Dopaminergic stabilizers for the treatment of schizophrenia : rat studies focusing on negative symptoms and mechanisms of action /." Göteborg : Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Göteborg University, 2007. http://hdl.handle.net/2077/7535.
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Strutton, David R. "The impact of treatment and treatment interactions on employment outcomes for individuals with schizophrenia and other severe mental disorders." Available to US Hopkins community, 2003. http://wwwlib.umi.com/dissertations/dlnow/308077.
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Olson, Paul O. "Experiences of mental illness, treatment and recovery in schizophrenia : an existential-phenomenological exploration." Thesis, Middlesex University, 2016. http://eprints.mdx.ac.uk/21226/.
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This study explores in depth the narratives and experience of recovery from a convenience sample of seven participants with a schizophrenia diagnosis, but now remitted (Andreasen et al, 2005). Three lifeworlds (phases) emerged using hermeneutic phenomenology: (A) Losing existential grounding; (B) Being-within-the-system (i.e. hospitalised); and (C) Outside schizophrenia. Outside has a double meaning as it both emerges from the narratives and also is an important base for existential exploration: what else needs to happen except psychiatry? Each lifeworld had a different meaning and different behaviours connected to it. Two necessary transitions were identified: First, accepting help; and second, an existential construction or re- construction depending on where in your life course you become affected. Psychotherapy was useful, but not necessary for remission and recovery.
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Gunes, Arzu. "Pharmacogenetics and Antipsychotic Treatment in Schizophrenia with Special Focus on Adverse Drug Reactions." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8656.
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Linnér, Love. "Noradrenergic augmentation strategies in the pharmacological treatment of depression and schizophrenia : an experimental study /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-253-1.
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Agbedjro, Deborah. "Using statistical and machine learning methods to improve treatment success in patients with schizophrenia." Thesis, King's College London (University of London), 2018. https://kclpure.kcl.ac.uk/portal/en/theses/using-statistical-and-machine-learning-methods-to-improve-treatment-success-in-patients-with-schizophrenia(22171de1-b666-4cd5-b974-2e2f2b930dfe).html.
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Background: People with schizophrenia (SCZ) suffer from impaired cognitive abilities and these are associated with poor functional outcomes. Cognitive Remediation Therapy (CRT) has been shown effective in improving the cognitive deficits of SCZ. Because there is evidence for CRT treatment heterogeneity of outcomes, there is a need to identify CRT predictors of differential response using moderation analysis of high dimensional psychiatric data, which typically contain relatively large percentages of missingness. This will contribute to precision medicine treatment, understanding mechanism responsible of differential therapy responses, and better prognosis. Aims: The primary aim of this PhD consisted of developing a CRT precision medicine model, using computer intensive statistical learning methods able to deal with high dimensional psychiatric data containing large percentages of missingness in the predictors and smaller per-centages in the outcome. Secondary aims were overcoming the following problems: variable selection or measurement of variable importance in the model, multicollinearity and overfitting, and summarising commensurate outcomes in one latent outcome. Methods: A simulation study comparing four statistical learning methods (Lasso, Elastic-net, Random Forests and Conditional Inference Random Forests) combined with two missing data imputation techniques (Multivariate Imputation using Chained Equations and MissForest) was run. The combined methods were assessed according to their optimism-corrected (via bootstrap internal validation) prediction accuracy and variable selection performance in differ-ent scenarios. The best method was chosen to develop a CRT precision medicine model using individual participant data from seven randomised controlled trials with approximately 400 pa-tients. Factor scores from a latent summary measure of cognitive commensurate outcomes, obtained via Factor Analysis, was used as the model dependent variable, to accommodate the above univariate statistical learning methods. Results: In the simulations, the method combining MissForest imputation with Lasso was the best compromise between prediction accuracy and clinical interpretability. MissForest-Lasso was then used to develop an internally validated precision medicine model, which se-lected only a weak moderator of treatment response. The model was therefore mainly prog-nostic. Conclusion: In future research, more modalities of data, such as genetics, OMICS and neuroimaging data, are recommended to successfully identify moderators of CRT success.