Rozprawy doktorskie na temat „Schizofrenia”

Bakgrund: Schizofreni är en sjukdom som drabbar cirka 1 % av befolkningen, men en evidensbaserad, effektiv behandling med få biverkningar saknas. Denna litteraturstudie syftar till att kartlägga kvalitetsindikatorer som utgör grunden för en god omvårdnad av patienter med schizofreni. Syfte: Att sammanställa och belysa kvalitetsindikatorer som förväntas säkerställa en god kvalitet i omvårdnad och bemötande av patienter med schizofreni. Design: Litteraturstudie Metod: Litteraturstudie av 17 vetenskapliga artiklar, en review-artikel samt fyra debattartiklar om behandling av schizofreni, som analyserats och kvalitetsgranskats för att kunna belysa vilka faktorer som utgör kvalitetsindikatorer vid omvårdnad av patienter med schizofreni. Resultat: Kvalitetsindikatorer vid omvårdnad av patienter med schizofreni är ett holistiskt synsätt där patienten står i centrum och vården ges av välutbildade vårdgivare. Patienten ska erbjudas möjlighet att vara aktiv i sin behandling. Behandlingsmetod ska väljas och/eller kombineras efter patientens individuella behov och önskemål samt syfta till att involvera anhöriga i vårdprocessen. Slutsats: Det finns många omvårdnadsmetoder för schizofreni, vilken som ger bäst effekt varierar då diagnosen är mycket individuell. Det är viktigt att vårdgivare i samråd med patienten anstränger sig för att finna den metod som passar individen bäst.

Background: Schizophrenia is a psychiatric diagnosis which affects about 1 % of the population. However, there is no evidence based effective treatment with limited side-effects available. This literature review seeks to clarify quality indicators which constitute the basis for a good treatment and care for patients with schizophrenia. Aim: To compile and illuminate quality indicators expected to guarantee good quality of the care and treatment received by patients with schizophrenia. Design: Literature study. Methods: For this review 17 scientific articles, one review and four papers on the subject of treatment of schizophrenia were analyzed and quality examined in order to illuminate the factors which constitute the basis of quality indicators for good treatment and care for patients with schizophrenia. Results: Quality indicators in caring for patients with schizophrenia constitute a holistic, patient centered approach. The caregivers are well educated and the patient is encouraged to take an active part in the treatment. The method of treatment should be chosen and/or combined in accordance with the patient’s individual needs and wishes. It also aims to include close relations in the caring process. Conclusion: There are many methods of treatment available for schizophrenia. It is however a very individual diagnosis, and which treatment gives the best effect varies from case to case. It is important that caregivers, while including the patient in the process, strive to find the method most suited to the individual.

Esperienze anomale del sé sono state associate ai disturbi dello spettro schizofrenico. Si ritiene che un debole senso del sé (sé minimale), un disturbato funzionamento corporeo implicito e della sintonizzazione intercorporea con gli altri siano manifestazioni di un sé corporeo disturbato nella schizofrenia (Sz). L’alterazione del sé minimale, correlata ai disturbi del riconoscimento di sé e della discriminazione sé-altro, dipende da deficit nell’ integrazione multisensoriale. Una delle esperienze di base del sé riguarda il senso di appartenenza del corpo (BO) che è legato sia alle parti corporee che al volto, un segno cruciale per la propria identità che consente di distinguerci dagli altri e di differenziarci dagli altri. La Sz è caratterizzata da deficit nel riconoscimento del proprio volto e di quello altrui, nonché da un BO alterato. Pertanto, lo scopo del primo studio è stato quello di integrare queste linee di ricerca indagando la propensione all'Enfacement Illusion (EI) nella Sz. I risultati hanno mostrato come l'EI abbia indotto la malleabilità del confine Sé-Altro sia nei controlli che nei pazienti; l’EI ha influenzato inoltre il confine Altro-Altro, suggerendo come l'EI non sia solo confinato alla sfera del sé, ma influenzi anche il modo in cui discriminiamo gli altri. Il secondo studio aggiunge nuove importanti evidenze nel contesto del sé corporeo nella Sz, focalizzandosi sul processamento implicito del sé corporeo, operazionalizzato nel cosiddetto effetto del vantaggio del sé (SAeff, rotazione mentale motoria più veloce con proprie parti corporee rispetto a quelle altrui in un giudizio di lateralità). I risultati hanno mostrato l'assenza del SAeff nella Sz rivelando un'alterazione nei processi sensorimotori delle proprie parti corporee, suggerendo una potenziale natura motoria distorta del sé minimale. Un altro aspetto cruciale che influenza tale senso del sé è la consapevolezza corporea, la sensazione di essere un sé corporeo nello spazio (sé spaziale), che dipende dall'integrazione di segnali multisensoriali che si verificano all'interno di una porzione di spazio circostante il corpo, lo Spazio Peripersonale (PPS). Il PPS non è fisso, ma si modella dinamicamente attraverso le esperienze motorie, come dopo l'uso di strumenti. Inoltre, l’estensione del PPS varia tra le persone al variare di diverse caratteristiche individuali, come la schizotipia (St). Tuttavia, ancora poco si conosce sulla relazione tra la plasticità del PPS e i tratti di personalità. A questo scopo, abbiamo studiato la plasticità del PPS dopo due diversi allenamenti motori (dopo l’utilizzo di uno strumento e dopo l’osservazione dell’utilizzo di quello strumento), lungo il continuum St. I risultati hanno mostrato l'espansione del PPS dopo l'uso dello strumento, mentre in seguito all’osservazione non è emersa alcuna espansione. Abbiamo riscontrato inoltre una maggiore espansione nel gruppo St relativamente basso rispetto a quello relativamente alto, indipendentemente dal tipo di allenamento motorio eseguito. Questi risultati sottolineano una potenziale alterazione funzionale del PPS all’aumentare del livello St. Tenendo conto dell'idea di un continuum che va dalla St alla psicosi conclamata, è ragionevole ipotizzare una minore malleabilità del PPS nella Sz. Nessuno studio ha fino ad ora indagato tale aspetto nella Sz; pertanto, questo rappresenta il focus dell'ultimo studio, che illustra i risultati preliminari sui pazienti Sz, rappresentando un altro importante contributo alla conoscenza del sé spaziale nella psicopatologia. Tutte queste evidenze arricchiscono l'attuale stato dell'arte dei disordini del sé minimale nella Sz, supportando l'idea di un sé fragile che si rompe in piccoli pezzi che includono molteplici aspetti corporei interrelati.
Anomalies of self-experiences have been associated with schizophrenia spectrum disorders. It has been proposed that the weak basic sense of self (‘minimal self’), the disturbed implicit bodily functioning and the disruption of intercorporeal attunement with others are manifestations of a disturbed bodily self in schizophrenia (Sz). This altered basic sense of self, strictly related to self-recognition and self-other discrimination impairments, have been linked to deficits in multisensory integration mechanisms. One of the basic experiences of self concerns the sense of body-ownership (BO) which is not only associated with body parts but also with the face, a crucial cue for self-identity allowing to distinguish the self from the others and in differentiating others. Sz is characterized by deficits in one’s own and others’ face recognition, as well as by a disturbed BO. Thus, the aim of the first study here presented was to integrate these lines of research investigating the Enfacement Illusion (EI) proneness in Sz. Results showed how EI induced the expected malleability of Self-Other boundary among both controls and patients; interestingly, it also demonstrated how Other-Other boundary is influenced by EI, suggesting how EI is not only confined to self-sphere but it also affects the way we discriminate others. The second study adds important new evidence in the context of the bodily self in Sz, focusing on the implicit bodily self processing, operationalized in the so-called self advantage effect (SAeff, a faster sensory motor mental rotation with self than others’ body-parts in a laterality judgment task). Results showed the absence of the SAeff in Sz revealing a specific alteration in the sensorimotor processes of self body parts, suggesting a potential distorted motor nature of the minimal self. Another crucial aspect shaping our sense of self is bodily self-awareness, the feeling of being a bodily self in space (spatial self). This experience depends on multisensory integration occurring within the portion of space surrounding our body, Peripersonal Space (PPS). PPS is not fixed, rather it dynamically shapes through motor experiences (e.g. after a tool-use). Moreover, the size of PPS largely varies across people depending on several individual characteristics, including schizotypy (St). However, little is still known about the relationship between PPS plasticity and personality traits. To this aim, we investigated PPS plasticity after two different motor trainings (i.e. after using a tool and after observing someone else using the tool), in participants along the St continuum. Results showed PPS expansion after tool-use, whereas absence of PPS expansion emerged after the observation task. Moreover, we found greater PPS expansion in the relatively-low St group than in the relatively-high one, regardless of the type of motor training performed. These results underline a potential general functional alteration of PPS with the increase of St level. Taking into account the idea of a dynamic continuum ranging from St to full-blown psychosis, it is reasonable to hypothesize a lesser malleability of PPS boundaries in Sz. No studies until now have investigated this functional aspect of PPS in Sz. Hence, this represents the focus of the last study that illustrates the preliminary results on Sz patients, constituting another relevant contribution to our understanding of the spatial self in psychopathology. Taken together, all this evidence enriches the current state of the art of the minimal self disorder in Sz, empirically supporting the idea of a fragile self, which shatters into a variety of small pieces that enclose multiple interrelated bodily aspects.

Terapia neurofeedback jest obecnie dynamicznie rozwijającą się formą interwencji neuropsychologicznej. Choć jej początki sięgają lat pięćdziesiątych dwudziestego wieku, to miniona dekada oraz rozwój komputeryzacji umożliwiły intensywny rozwój prac nad opisywaną metodą oraz stosowanie jej na szeroką skalę. Terapię neurofeedback stosuje się w leczeniu zespołu nadpobudliwości psychoruchowej z deficytem uwagi, zespołu deficytu uwagi, uzależnień, migren, zaburzeń lękowych, nastroju. Ponadto w rehabilitacji po chorobach i urazach neurologicznych oraz jako metodę treningu funkcji poznawczych dla osób zdrowych (Tyl, Tylová, 2005). Wielokrotnie udowadniano, że terapia neurofeedback jest skuteczną metodą rehabilitacji procesów poznawczych u osób niepsychotycznych (por. Fuchs i in., 2003; Egner, Gruzelier, 2001; Pakszys, 2002a). Badania Schneider’a i współpracowników (1992), a także Gruzelier’a i współpracowników (1999) pokazują, że osoby cierpiące na schizofrenię dzięki opisywanej terapii również są zdolne do zmiany czynności bioelektrycznej mózgu. Wniosek ten jest zbieżny z doświadczeniem klinicznym autora – dotychczasowa praca opisywaną metodą z pacjentami psychotycznymi przynosiła pozytywne zmiany zauważane przez personel medyczny, pacjentów oraz ich rodziny. Biorąc pod uwagę z jednej strony rolę zaburzeń poznawczych w procesie schizofrenicznym, a z drugiej wysoką efektywność metody neurofeedback w terapii zaburzeń poznawczych u osób niepsychotycznych, zastanawiający jest fakt, iż dotychczas nie przeprowadzono badań nad skutecznością opisywanej metody w leczeniu schizofrenii. Celem przeprowadzonych badań było ustalenie, czy terapia neurofeedback jest skuteczną metodą leczenia zaburzeń poznawczych u pacjentów cierpiących na schizofrenię paranoidalną. Problem należy uznać za istotny zarówno z punktu naukowego jak i społecznego. Wysoka skuteczność umożliwia włączenie opisywanej metody do procesu leczenia pacjentów schizofrenicznych, np. na psychiatrycznych oddziałach dziennych leczących pacjentów w remisji.

L'ipotesi che l'ossido nitrico (NO) possa esercitare un ruolo eziopatogenetico nei disturbi psichiatrici è stata supportata da diverse evidenze scientifiche presenti in letteratura, eppure ad oggi non sono state ancora ben chiarite le modalità secondo cui attribuire valore diagnostico/terapeutico al riscontro di tali alterazioni. MATERIALI E METODI: Lo studio osservazionale naturalistico ha coinvolto 25 pazienti affetti da schizofrenia e 25 controlli sani, di entrambi i sessi. Sono state somministrate la Structured Clinical Interview for DSM (SCIDà à ¢ II) per la valutazione della personalità e la PANSS (Positive And Negative Syndrome Scale) per la valutazione delle dimensioni positiva, negativa e generale della schizofrenia. Dal prelievo ematico è stato effettuato il dosaggio dei nitriti e dei nitrati. I pazienti erano tutti in trattamento farmacologico al momento del prelievo: 9 pazienti con olanzapina (OLA) (5-15 mg/die); 8 pazienti con aloperidolo (ALO) (3-10 mg/die); 8 pazienti con risperidone (RSP) (2-6 mg/die). RISULTATI: I valori dei nitrati nei pazienti schizofrenici risultavano 30,92 à ± 6,05 à µM, mentre nei controlli sani si registrava 26,78 à ± 6,31 à µM (p=0,025). Nel confronto intra-gruppi tra pz in trattamento: 38,9 à à à ± 2,77 à à à µM (ALO); 31 à ± 1,08 à µM (RSP); 25,04 à ± 6,05 à µM (OLA), con una differenza altamente significativa (p<0,001). I punteggi della PANSS erano direttamente correlati alle alterazioni dellà à ¢ NO: ALO vs RSP: p=0,006; ALO vs OLA: p<0,001; RSP vs OLA: p<0,001. CONCLUSIONI: L'ipotesi che i livelli dell'NO fossero correlati alla presenza di schizofrenia e' stata confermata dalla nostra ricerca che nel confronto tra pazienti e controlli sani ha messo in evidenza una differenza statisticamente significativa (p=0,025) dei livelli circolanti dei nitrati. Alcuni trattamenti farmacologici sembrano normalizzare tali alterazioni, con una maggiore evidenza per gli antipsicotici di seconda generazione.
INTRODUCTION: The hypothesis that nitric oxide (NO) can exert a pathogenetic role in psychiatric disorders has been supported by several evidence in the literature, but the manner in which attribute value to diagnostic / therapeutic of finding these changes yet been not well clarified. MATERIALS AND METHODS: The naturalistic observational study involved 25 patients with schizophrenia and 25 healthy controls of both sexes. Were administered the Structured Clinical Interview for DSM (SCID-II) for personality assessment and the PANSS (Positive And Negative Syndrome Scale) for assessing the size of positive, negative and general psychopathology of schizophrenia. Since blood sampling was performed the determination of nitrite and nitrate. The patients were all treated at baseline: olanzapine (OLA) 5-15 mg/day (n=9 pz), haloperidol (ALO) 3-10 mg/day(n=8 pz), risperidone (RSP) 2-6 mg/day (n=8 pz). RESULTS: The values of nitrate in schizophrenic patients were 30.92 à ± 6.05 M, while in healthy controls was recorded 26.78 à ± 6.31 M (p = 0.025). In intra-group comparison between patients in treatment: 38.9 à ± 2.77 M (ALO), 31 à à ± 1.08 M (RSP), 25.04 à ± 6.05 M (OLA), with a highly significant difference ( p <0.001). The scores of the PANSS were directly related to the alterations of NO: ALO vs. RSP: p = 0.006; ALO vs OLA: p <0.001 vs OLA RSP: p <0.001. CONCLUSIONS: The hypothesis that the levels of NO were related to presence of schizophrenia was confirmed by our research that shows statistically significant difference (p = 0.025) between patients and healthy controls in circulating levels of nitrates. Some drug treatments seem to normalize these alterations, with increased evidence for second-generation antipsychotics.

La schizofrenia rappresenta uno dei più grandi enigmi per l’impresa conoscitiva umana: non si conosce la sua eziologia, né le sue basi biologiche e cerebrali. Non è neanche chiaro cosa accada nell’esperienza di chi ne soffre, che sembra vivere in un mondo altro. La scarsa conoscenza dell’esperienza schizofrenica e la distanza tra questa e il senso comune hanno portato molti studiosi a inquadrare questo disturbo come illogico, irrazionale, insensato. Il presente lavoro tenta di confutare tale impostazione, mostrando come il mondo di senso dello schizofrenico si altera, non si disgrega; si trasforma, non si annulla. Il campo di studi all’interno del quale si colloca la ricerca è la semiotica, disciplina che studia i sistemi e i processi di significazione e i modi attraverso cui l’essere umano dà senso al mondo. L’intera indagine è inserita in un quadro interdisciplinare in costante dialogo con la psicopatologia fenomenologica e le scienze cognitive contemporanee, e si sviluppa a partire da numerosi testi autobiografici di pazienti schizofrenici, report psichiatrici, articoli di giornale, film e romanzi sul tema. L’ipotesi su cui si muove il lavoro è che sia possibile comprendere la schizofrenia come un problema costitutivamente semiotico, il cui nucleo è da rintracciarsi in una radicale metamorfosi delle modalità di produrre e interpretare il significato. La scommessa sottesa è che la semiotica possa contribuire in modo sostanziale alla comprensione delle modalità attraverso cui la nostra cultura concettualizza la schizofrenia e dei modi in cui gli schizofrenici danno senso al mondo. Il lavoro indaga, quindi, i legami tra schizofrenia e cultura, la storia del concetto nosografico, e le alterazioni dei processi di significazione nei casi di eloquio disorganizzato, nei racconti autobiografici e nei deliri, cercando anche di fornire strumenti utili alla pratica clinica.
Schizophrenia represents one of the greatest enigmas for human knowledge: its aetiology is unknown, as its biological and neurological basis. It is even unclear what happens in the sufferers' experience, who seem to live in another world. The lack of knowledge of the schizophrenic experience and the distance between this experience and common sense have led many scholars to define this disorder as illogical, irrational, and senseless. On the contrary, the present work shows how the schizophrenic world of meaning alters, does not disintegrate; it changes, does not dissolve. The investigation is situated in an interdisciplinary framework where Semiotics, the discipline that accounts for systems and processes of signification, dialogues with phenomenological psychopathology and contemporary cognitive sciences. The inquiry is developed by taking into account several autobiographical texts of schizophrenic patients, psychiatric reports, newspaper articles, movies and novels on this subject. The leading hypothesis is that it is possible to understand schizophrenia as a constitutively semiotic problem, represented by a radical metamorphosis of meaning production and interpretation. So the bet we made is that Semiotics can contribute to understanding how our culture conceptualises schizophrenia, and the ways in which people with schizophrenia make sense of the world. Therefore, the thesis investigates the links between schizophrenia and culture, the history of the nosographic concept, and the alterations of the signification processes in disorganised speech, autobiographical narratives, and delusions, providing valuable tools for clinical practice.

Schizophrenia is a serious mental illness affecting 1% of the population. It is characterized by symptoms: hallucinations, delusions, negative symptoms, disorganized behavior and thinking. It is connected with changes in the brain structures and neurotransmission, which is associated with cognitive dysfunctions. These factors significantly limit the social and professional functioning of people suffering from it. Nevertheless, so far, literature has not focused on an important topic related to the functioning of schizophrenic patients in the economic sphere. The study included 31 patients suffering from schizophrenia and a control group consisting of 30 clients of social welfare centers who were not mentally ill, and their household incomes were close to those with schizophrenia. The study was divided into stages due to application of numerous research tools. Information about economic functioning, material and family situation was collected. The Financial Operational Characteristics Questionnaire was used as well as the Questionnaire of Attitudes to Financial Behavior by Grażyna Wąsowicz-Kiryło. The tools used to assess cognitive functioning were also applied. The research method ("Shop") was constructed by the author, it allowed simulation of shopping. In addition, the financial competence of the respondents was assessed, as well as the severity of the symptoms of schizophrenia using Clinican-Rated Dimensions of Psychosis. The obtained results point to the poor financial situation of people with schizophrenia, who often remained dependent on their relatives. Usually, they received pensions and benefits, they rarely took up a job. They were characterized by low independence, poor knowledge about the needs of the household. They showed difficulties in planning their daily purchases and their performance. They perceived themselves as unable to postpone immediate gratification, but nevertheless the observation of their actual behavior did not confirm that. When shopping their tendency to choose a small number of products was noticed, but the products were usually relatively expensive. Patients had relatively poor knowledge of the prices of articles. In addition, there were some difficulties in solving simple financial problems among patients with schizophrenia. Among the characteristics of financial functioning dominated: financial temporal perspective focused on the present and poor reflexivity of making financial decisions. The results obtained in the study allowed to draw important practical and application conclusions. Based on them, guidelines were formulated for possible interactions to improve the economic functioning of patients suffering from schizophrenia, which may be undertaken as part of the work of the environmental treatment team.

Sensorimotor gating is a perceptual process aimed at filtering out irrelevant information. In humans and animal models, this function can be operationally measured through the prepulse inhibition (PPI) of the acoustic startle reflex. Notably, PPI deficits are associated with numerous neuropsychiatric conditions characterized by gating disturbances and personality aggressive traits, including schizophrenia and Tourette syndrome. Nevertheless, the mechanism underlying the physiopathology is poor understood, principally by the lack of valid animal models. Given the genetic and environmental interplay in schizophrenia background onset, we tested a (endo)phenotype of schizotypal behavior associated with aggression, provided by a MAO-A deficient mice line subjected to early psychosocial stress. Interestingly, these animals represent an isomorphic model of human condition of MAO-A polymorphism, related to antisocial personality and increased aggression. We investigated drug sensibility on sensorimotor gating function across different rat and mice strains to elicit differences due to genetic background in PPI response. Furthermore, we tested MAO-A deficient mice mutant with resident-intruder test to asses early stress impact on aggressive and antisocial behavior.

Overwhelming evidence suggests that compromised neuropsychological function is frequently observed in schizophrenia. Neurocognitive dysfunction has often been reported in bipolar spectrum disorders, although there are inconsistencies in the literature. Neurocognitive functioning may represent an indicator of genetic risk and poor functional outcome in both schizophrenia and bipolar disorder. The degree and pattern of impairment between psychiatric groups have rarely been compared, especially when subjects are psychiatrically stable. In this study we compared clinically stable schizophrenic spectrum patients (n.46), bipolar spectrum patients (n.53), controls (n.45) and first-degree relatives without psychiatric disorder (n.10). Psychopathology, global functioning and neurocognitive functioning were assessed. Both bipolar subjects and schizophrenic subjects differed from control subjects in neurocognitive function, which was independent from both age of onset and illness duration. Bipolar and schizophrenic patients shared the same pattern of neuropsychological impairment, although bipolar spectrum performed a little better; there were only small quantitative differences across the two diagnostic groups . This finding is consistent with the idea that there are common mechanisms that underlie different diseases and with a growing emphasis on identifying core neural systems in the psychotic continuum
Vi sono crescenti evidenze a favore di una compromissione neurocognitiva nei disturbi schizofrenici; tali disfunzioni sono state osservate anche nei disturbi bipolari, ma con dati ancora contrastanti. In entrambe le patologie, il funzionamento neurocognitivo è un importante indicatore di esito e può rappresentare un marker specifico di vulnerabilità di malattia. Sono ancora pochi gli studi che hanno confrontato il profilo e il grado di compromissione cognitiva nei due spettri patologici, soprattutto in fase di stabilità clinica. In questo studio abbiamo confrontato pazienti stabili dal punto di vista psicopatologico con diagnosi di spettro schizofrenico (n.46), di spettro affettivo-bipolare (n.53), controlli sani (n.45) e familiari di I grado non affetti (n.10); i soggetti sono stati valutati con scale psicometriche per la psicopatologia e il funzionamento globale, e con una batteria di test neuropsicologici per l’assetto neurocognitivo. Abbiamo riscontrato differenze significative sia dei pazienti dello spettro schizofrenico sia dello spettro bipolare, rispetto ai controlli sani, per quanto riguarda la performance cognitiva, che è apparsa non correlata all’età di esordio e alla durata di malattia. E’ emerso un pattern condiviso di compromissione neuropsicologica, di grado lievemente meno severo di disfunzione nello spettro bipolare: sono infatti state riscontrate solo lievi differenze di tipo quantitativo tra i due gruppi diagnostici. Tale dato avvalora l’ipotesi secondo cui le maggiori patologie psichiatriche condividono meccanismi neurali di base in un continuum psicotico

BACKGROUND Schizofrenic and bipolar disorder are complex and disabling psychiatric diseases, whose recent neurobiological, neuropsychological, genetic and brain imaging findings are in contrast with the traditional categorical approach of psychiatric nosography. Schizophrenia has been for many years at the center of the interest of research in the psychiatric field, but, only recently, studies have compared the schizophrenic disorder with bipolar disorder and have considered these diseases in a spectrum and continuum perspective. In particular, the neurocognitive aspects of diseases are more numerous than the positive symptomatology, patient’s outcome, and because they are possible endophenotypic markers of vulnerability to the pathology. However, rather than a single cognitive profile corresponding to each diagnostic categories, recent studies have identified significant intra- and cross-diagnostic variability in patterns of cognitive impairment. Purpose of the research In a sample of schizophrenia spectrum patients, of psychopathologically stable affective-bipolar spectrum, and in a sample of healthy controls and unaffected relatives of first-degree, it was performed a neuropsychological assessment, using a battery of neuropsychological tests. The goal of this study was to contribute to the literature on cognitive heterogeneity in mood disorders by identifying cognitive subprofiles in a population of patients with schizophrenic and bipolar disorder, and healthy controls. Because of these reasons, the aim of this study is: 1. to Determine affinities and differences in neuropsychological performance in patients belonging to the schizophrenic and bipolar spectrum, in clinical stability phase, compared to healthy control and first-degree relatives of patients without psychiatric pathology; 2. to Investigate possible correlations of cognitive performance with some clinical variables such as age, age of onset and duration of disease; 3. to Investigate the presence of cognitive heterogeneity in schizophrenic and bipolar spectrum disorders by identifying cognitive sub profiles in the pathological population and proceeding with a cluster analysis. Materials and methods A sample of 38 schizophrenic patients and 50 bipolar patients in clinical stability phase, belonging to the Mental Health Department of Conegliano ULSS-7, and a sample of 51 healthy controls and 10 first-degree relatives of patients without psychiatric pathology were taken into consideration. All subjects underwent neurocognitive assessment by submitting a neuropsychological battery of tests taken from the Short Neuropsychological Exam (ENB) and through the Wisconsin Card Sorting Test (WCST). Psychometric scales (BPRS, VGG, PANSS, HAM-D, HAS, YMRS) were assigned to the patients in order to evaluate their clinical status. Results We found significant differences in both schizophrenic patients and bipolar patients, compared to healthy controls and relatives, regarding cognitive performance, which appeared unrelated to age, age of onset and duration of disease. A shared pattern of neuropsychological impairment emerged, with a slightly less severe degree of dysfunction in bipolar patients: only slight quantitative differences were found between the two diagnostic groups, except for the 30-second Interference Memory which achieved statistical significance. Performance at neuropsychological tests does not correlate with age, age of onset and duration of disease: deficits are present from the onset and remain relatively stable during the course of the disease. The two factors identified by factorial analysis, group the tests that measure the cognitive functions of two cognitive domains, both compromised in the two pathological groups, namely: Executive functions (Factor 1) and Attention (Factor 2). Specifically, the tests that determine FACTOR 1 are: Immediate and deferred prose Memory, Verbal fluency, TMT B and Digit span backward; while the tests that identify the FACTOR 2 are: Memory with 10 sec. and 30 sec. interference, TMT A and TMT B. Conclusions In this study, a picture of impairment of cognitive functions in patients of the schizophrenic-bipolar spectrum emerges. In agreement with the results of other studies in literature, our outcome confirms the hypothesis according to which the major psychiatric pathologies share basic neural mechanisms in a psychotic continuum. The identification of specific cognitive alterations could represent a crucial step in identifying neuropsychological clusters in schizophrenic-bipolar spectrum disorders.
Presupposti dello studio Disturbo bipolare e schizofrenia sono malattie psichiatriche complesse e invalidanti, nelle quali il tradizionale approccio categoriale della nosografia psichiatrica entra in continuo dibattito in relazione alle più recenti scoperte nei campi della neurobiologia, della genetica, della neuropsicologia e del brain imaging. La schizofrenia è da molti anni al centro dell’interesse della ricerca in ambito psichiatrico, ma solo in tempi recenti gli studi hanno confrontato il disturbo schizofrenico con il disturbo bipolare e hanno considerato queste patologie in un’ottica di spettro e di continuum. In particolare, gli aspetti neurocognitivi di queste malattie rivestono oggi un’importanza crescente sia perché indicatori, ancor più della sintomatologia positiva, dell’outcome funzionale, sia perché possibili markers endofenotipici di vulnerabilità alla patologia. Tuttavia, piuttosto che un singolo profilo cognitivo corrispondente a ciascuna categoria diagnostica, studi recenti hanno identificato una significativa variabilità intra- e cross-diagnostica nei pazienti che presentano disfunzioni cognitive. Scopo dello studio In un campione di pazienti con diagnosi di spettro schizofrenico, di spettro affettivo-bipolare stabili dal punto di vista psicopatologico, e in un campione di controlli sani e familiari di I grado non affetti, è stata eseguita una valutazione neurocognitiva, mediante un’apposita batteria di test neuropsicologici. L'obiettivo di questo studio è quello di contribuire alla letteratura sull'eterogeneità cognitiva nei disturbi dello spettro schizofrenico e bipolare identificando i subprofili cognitivi in ​​una popolazione di pazienti con diagnosi di disturbo schizofrenico e disturbo bipolare. Il presente studio si propone pertanto di: 1. Determinare affinità e differenze nelle performance neuropsicologiche in pazienti appartenenti allo spettro schizofrenico e bipolare, in fase di stabilità clinica, rispetto a soggetti di controllo e familiari di I grado dei pazienti non affetti da patologia psichiatrica; 2. Indagare eventuali correlazioni della performance cognitiva con alcune variabili cliniche come l’età, l’età di esordio e la durata di malattia; 3. Indagare la presenza di eterogeneità cognitiva nei disturbi dello spettro schizofrenico e bipolare identificando i subprofili cognitivi nella popolazione patologica e procedere con un’analisi dei cluster. Metodi e materiali Sono stati presi in considerazione un campione di 38 pazienti schizofrenici e 50 pazienti bipolari in fase di stabilità clinica, afferenti al Dipartimento di Salute Mentale Ospedale di Conegliano ULSS-7, e un campione di 51 controlli sani e 10 familiari di I grado non affetti. Tutti i soggetti sono stati sottoposti a valutazione neurocognitiva mediante la somministrazione di una batteria neuropsicologica di test tratti dall’Esame Neuropsicologico Breve (ENB) e mediante il test Wisconsin Card Sorting Test (WCST). Ai pazienti sono state somministrate delle scale psicometriche (BPRS, VGG, PANSS, HAM-D, HAS, YMRS) al fine di valutarne lo stato clinico. Risultati Abbiamo riscontrato differenze significative sia dei pazienti schizofrenici sia dei pazienti bipolari, rispetto ai controlli sani e ai familiari, per quanto riguarda la performance cognitiva, che è apparsa non correlata all’età, all’età di esordio e alla durata di malattia. E’ emerso un pattern condiviso di compromissione neuropsicologica, di grado lievemente meno severo di disfunzione nei pazienti bipolari: sono infatti state riscontrate solo lievi differenze di tipo quantitativo tra i due gruppi diagnostici, tranne per la Memoria con interferenza 30 sec. che ha raggiunto una significatività statistica. Le prestazioni ai tests neuropsicologici non correlano con età, età di esordio e durata di malattia: i deficit sono presenti sin dall’esordio e rimangono relativamente stabili durante il decorso della malattia. I due fattori identificati con l’analisi fattoriale, raggruppano i tests che misurano le funzioni cognitive di due domini cognitivi, entrambi compromessi nei due gruppi patologici, ovvero: Funzioni esecutive (Fattore 1) e Attenzione (Fattore 2). Nello specifico i tests che determinano il FATTORE 1 sono: Memoria di prosa immediata e differita, Fluenza verbale, TMT B e Digit span backward; mentre i tests che identificano il FATTORE 2 sono: Memoria con interferenza 10 sec. e 30 sec., TMT A e TMT B. Conclusioni In questo studio emerge un quadro di compromissione delle funzioni cognitive nei pazienti dello spettro schizofrenico-bipolare. In accordo con i risultati di altri studi presenti in letteratura, il nostro riscontro si pone come conferma dell’ipotesi secondo cui le maggiori patologie psichiatriche condividono meccanismi neurali di base in un continuum psicotico. L’identificazione di alterazioni cognitive specifiche potrebbe rappresentare un passo cruciale nell’individuare cluster neuropsicologici nei disturbi dello spettro schizofrenico-bipolare.

Introduzione: crescenti evidenze individuano associazioni fra polimorfismi genici dei recettori dopaminergici, serotoninergici e glutammatergici e la risposta clinica alla terapia antipsicotica. In letteratura vengono descritti polimorfismi verosimilmente predittivi di una migliore risposta clinica. Inoltre la valutazione dei livelli plasmatici della terapia antipsicotica può migliorare la conoscenza del metabolismo del paziente e indirizzare il clinico sulla scelta di posologie personalizzate. Materiali e Metodi: 84 pazienti affetti da schizofrenia, in fase stabile di malattia e in trattamento con farmaci long-acting di nuova generazione (Paliperidone, Risperidone, Olanzapina, Aripiprazolo) sono stati arruolati (T0) presso l’Università di Foggia e valutati a 3 (T1) e 6 mesi (T2) attraverso follow-up clinico e psicometrico (PANSS, BPRS, CGI). Sono state inoltre effettuate valutazioni personologiche (NEO, TCI), cardiometaboliche, sono stati determinati i polimorfismi per i recettori della dopamina DRD2 e glutammato GRM3, i livelli plasmatici di farmaco antipsicotico allo steady-state della terapia long-acting. Risultati: le analisi statistiche effettuate evidenziano una associazione fra il polimorfismo per il GRM3 rs274622 e il miglioramento alle scale psicometriche nei sei mesi di osservazione. Lo stesso polimorfismo correla con tratti personologici di auto-direzionalità mentre i polimorfismi GRM3 rs1468412 e DRD2 rs6277 correlano rispettivamente con tratti personologici di amicalità e apertura all’esperienza. I pazienti riportanti polimorfismo GRM3 rs1468412 mostrano più elevati livelli di lipidi ematici accompagnati da un aumento della media della circonferenza vita. I livelli plasmatici dei farmaci antipsicotici sono inoltre associati a quelli di prolattinemia poiché noto il rapporto di dose-dipendenza. Infine maggiori livelli di morbilità psichiatrica sono stati riscontrati fra i pazienti in trattamento con risperidone rispetto agli altri antipsicotici. Conclusioni: Il nostro studio ha evidenziato delle iniziali significatività che permettono di correlare la risposta alle terapie antipsicotiche long-acting alla variabilità genetica individuale. Questi dati preliminari sembrerebbero confermare, in particolare, il coinvolgimento del sistema glutammatergico nella risposta farmacologica individuale
Introduction: growing evidences show possible associations between SNPs of receptors for dopamine, serotonin and glutamate and clinical outcomes of antipsychotic therapy. Moreover, plasma concentrations of antipsychotics may help clinicians to manage therapies and their dosages on the base of patient’s metabolism (tailored therapy). Methods and materials: 84 patients affected by schizophrenia and receiving antipsychotic long-acting therapies (Paliperidone, Risperidone, Olanzapine, Aripiprazole) have been enrolled (T0) at University of Foggia and followed at 3 (T1) and 6 (T2) months employing clinical rating scales (PANSS, BPRS, CGI). Personality tests (NEO, TCI), cardiometabolic measurements, genetic analyses for the SNPs of receptors DRD2 and GRM3 and plasma concentration measurements of antipsychotic therapies have been performed. Results: significant association between GRM3 rs274622 and patients’ clinical outcome (measured at PANSS and BPRS) has been found. Also, GRM3 rs274622 is associated with self-directedness at TCI whereas GRM3 rs1468412 e DRD2 rs6277 are associated to agreeableness and openness to experience at NEO. GRM3 rs1468412 is associate to higher levels of serum lipids and higher waist circumference. Plasma concentrations of any antipsychotics are related to prolactin serum levels as well as higher psychiatric morbidity is associated to treatment with long- acting risperidone. Conclusions: this study confirms the association between genetic variability and clinical outcomes in patients affected by schizophrenia and treated with antipsychotic medications. In particular, data suggest an involvement of glutamate in the clinical response to antipsychotic therapies.

Background: I disturbi del linguaggio, e in particolare l’impoverimento e la disorganizzazione, costituiscono un aspetto centrale della schizofrenia. Tali deficit sono stati descritti sia in termini di disturbi formali del pensiero (disordine nella forma ma non nel contenuto del pensiero), sia come alterazioni simili a quelle presenti nei disturbi di tipo afasico (es. creazione di neologismi). Inoltre, sono stati evidenziati deficit a livello fonologico, difficoltà nel recupero lessicale e una riduzione della complessità sintattica, così come disturbi inerenti la pragmatica (comprensione delle espressioni figurate, prosodia linguistica e affettiva, theory of mind). Negli ultimi decenni, le ricerche condotte mediante tecniche di neuroimaging hanno indicato il giro temporale superiore (GTS) e le sue sottoaree, il giro di Heschl (HG) e il planum temporale (PT), come componenti essenziali del network fronto-temporale coinvolto nella produzione e comprensione del linguaggio. Inoltre, tali studi hanno evidenziato la presenza di anomalie strutturali in HG e GTS, così come un’inversione della normale asimmetria del PT nei pazienti con schizofrenia rispetto ai controlli sani. Tali anomalie potrebbero costituire il substrato neurale dei disturbi del linguaggio descritti nella schizofrenia. Obiettivo dello studio: Valutare l’esistenza di differenze strutturali (volumetriche) di GTS, HG e PT, dell’indice di lateralizzazione del PT e relativamente ad alcuni indici linguistici/pragmatici in un gruppo di pazienti affetti da schizofrenia (DSM-IV) e in gruppo di controlli sani. Inoltre l’obiettivo è di indagare la correlazione tra i volumi delle aree anatomiche di interesse e gli indici linguistici/pragmatici. Metodi: Cinquantotto pazienti con diagnosi di schizofrenia (età media±ds: 40.60±11.58; lunghezza di malattia: 13.92±10.79; 40 maschi, 18 femmine; destrimani; caucasici) e 59 controlli sani (età media±ds: 40.69±11.10; 32 maschi, 27 femmine; destrimani; caucasici) hanno eseguito una risonanza magnetica strutturale (sMRI) effettuata con uno scanner da 1.5 Tesla. Il giro temporale superiore, il giro di Heschl e il planum temporale sono stati tracciati manualmente e il rispettivo volume è stato calcolato mediante il software Brains2. Un task narrativo (descrizione di vignette) e una conversazione semi-strutturata sono stati utilizzati per la valutazione della produzione linguistica, mentre test di comprensione della sintassi e delle espressioni figurate sono stati utilizzati per gli aspetti relativi alla comprensione dell’eloquio. Infine, è stata utilizzata una correlazione parziale per studiare la relazione tra i volumi ottenuti e gli indici linguistici risultati significativamente diversi nei due gruppi. Risultati: Per quanto riguarda il volume di GTS, HG e PT, non sono emerse differenze tra il gruppo dei pazienti e il gruppo dei controlli. Tuttavia, quando i gruppi sono stati stratificati in base al sesso, è emersa una riduzione del volume del PT sinistro e una riduzione della sua asimmetria nelle pazienti di sesso femminile rispetto ai controlli dello stesso sesso (volume PT: F=4.54, p= 0.04; indice di asimmetria del PT: F=4.69, p=0.04; ANOVA, età e volume totale intracranico come covariate). Per quanto riguarda l’assessment linguistico, i pazienti con schizofrenia hanno mostrato un deterioramento diffuso degli aspetti sia propriamente linguistici che pragmatici, in particolare riguardo la fluenza dell’eloquio (numero di parole al minuto), la complessità e diversità sintattica, la diversità lessicale, la comprensione delle regole della sintassi e delle espressioni figurate (idiomi e metafore) (p<0.01, MANOVA con età, sesso e livello di istruzione come covariate). Inoltre, dimensioni linguistiche distinte sono risultate correlate differentemente con i volumi di GTS-HG-PT nel gruppo dei pazienti e in quello dei controlli sani, in particolare riguardo la fluenza dell’eloquio, gli indici relativi alla sintassi e la comprensione di espressioni idiomatiche e metaforiche. Conclusioni: Il presente studio ha evidenziato alterazioni strutturali del PT nelle pazienti affette da schizofrenia rispetto ai controlli dello stesso sesso. E’ inoltre emersa la presenza di numerosi deficit linguistici nei soggetti con schizofrenia, quando confrontati con il gruppo di controllo. Inoltre, gli indici linguistici sono risultati correlare in maniera differenziata tra i due gruppi con i volumi delle regioni anatomiche investigate. Tali risultati suggeriscono l’importanza di condurre studi distinti per maschi e femmine (così come per destrimani e sinistrorsi) e inseriscono questo progetto di ricerca nel dibattito sulle differenze di genere nella schizofrenia. Studi futuri e con campioni più numerosi potranno chiarire se le differenze riscontrate tra i due sessi dal punto di vista anatomico possono risultare in una diversa competenza linguistica.
Background: Language disturbances, such as impoverishment, disorganization and dysregulation, are prominent features of schizophrenia. These deficits have been described in patients both in term of thought disorders and schizophasia (dysphasia-like impairments such as neologism, clanging, unintelligible utterance). Moreover, phonetics, access to the lexicon and sometimes syntax are clearly impaired, along with pragmatic deficits (impaired affective/linguistic prosody, theory of mind, non literal expressions comprehension). In the last decades, researches carried out with neuroimaging techniques have suggested the superior temporal gyrus (STG) and its sub-areas, Heschl’s gyrus (HG) and planum temporale (PT), as essential components of the fronto-temporal network involved in speech perception and production. Also, they have highlighted structural abnormalities in HG and STG (especially the left side) and an inversion of PT asymmetry in patients with schizophrenia compared to healthy controls. Such anatomical findings could be linked to language disturbances described in schizophrenia. Aim of the study: To compare STG, HG and PT volumes, PT lateralization index and linguistic/pragmatic dimensions in a sample of patients with a DSM-IV diagnosis of schizophrenia and healthy controls; to investigate correlations between volumes and linguistic/pragmatic indices. Methods: Fifty-eight patients with schizophrenia (mean age±sd: 40.60±11.58; duration of illness: 13.92±10.79; 40 males, 18 females; all right-handed; all Caucasian) and 59 healthy controls (mean age±sd: 40.69±11.10; 32 males, 27 females; all right-handed; all Caucasian) underwent 1.5 T structural magnetic resonance imaging (sMRI). Superior temporal gyrus, HG and PT were manually traced and volumes were calculated using the BRAINS2 software. Narrative, conversational and syntactic comprehension tasks were used to evaluate linguistic skills, while a pragmatic comprehension test was used to assess the ability to understand non literal aspects of language (metaphors and idioms). A partial correlation was used to investigate the link between volumes and linguistic/pragmatic indices. Results: As regards STG, HG and PT volumes, any differences was found between patients and healthy controls. When groups were stratified by sex, a left PT volume loss and a reduced right to left asymmetry was found only in the female patients compared to females controls (PT volume: F=4.54, p= 0.04; PT asymmetry index: F=4.69, p=0.04; ANOVA, age and intracranial volume as covariates). As regards language, patients with schizophrenia showed a widespread impairment of linguistic and pragmatic indices, especially regarding speech fluency, syntactic complexity and diversity, lexical diversity, syntactic rules understanding and non-literal expression comprehension (p<0.01, MANOVA with age, sex and educational level as covariates). Furthermore, distinct language dimensions differently correlated with STG-HG-PT volumes in patients with schizophrenia and controls, particularly with regard to speech fluency, syntactic measures and metaphor/idiom comprehension (p<0.01, partial correlation with age and duration of illness as covariates). Conclusion: This study has highlighted structural anomalies in the PT in females patients with schizophrenia compared to healthy females. Also, several linguistic and pragmatic deficits have been found in patients with schizophrenia compared to controls. Furthermore, distinct correlations between volumes and linguistic indices in patients with schizophrenia and healthy controls suggest a complex neuroanatomical substrate for language dimensions in healthy humans and in schizophrenia patients. In addition, such results suggest the importance to plan studies separately for males and females (and for left-handers/right-handers) in order to reduce the role of confounding variables. Further studies with larger samples should clarify whether these anatomical sex differences in language networks could result in different linguistic abilities.

In order to identify susceptibility loci for schizophrenia (SZ) and bipolar disorder (BPD), we collected clinical informations and biological sample of patients affected by SZ, BPD and schizoaffective disorder (SA), in collaboration with Mental Health Centre of Chioggia. Recent findings, emerging from genetic studies, support the evidence that these diseases share a number of susceptibility genes. Accordig to this theory, we carried out genetic and molecular analysis to better undestand schizophrenia and its associated disorders in their genetic context. By performing these analysis we were able to: 1) Collect clinical and anagraphical informations about the 40 pedigrees with high loading for schizophrenia and bipolar disorder. For each family, pedigree structure was traced back to tree generations using both church registers and demographical records. Additionally, we genotyped microsatellite markers on chromosome Y to evaluate the possibility of common male ancestor. 2) Assess the weight of genetic component and the mode of inheritance of SZ/BPD, in the pedigrees. We performed a complex segregation analysis (in collaboration with Prof. Scapoli); the results suggest that a main additive gene, plus a residual polygenic component is the best fitting hereditary model for the collected sample (Scapoli et al., 2006). 3) Find susceptibility loci with a genome wide search (GWS) in 16 multigenerational pedigrees with a high loading of the diseases (57 subjects). We genotyped 489 microsatellite markers (465 in the first scan and 24 in the fine-mapping analysis) and we calculated, using a multipoint approach, LOD score parametric and non parametric (NPL). The higher LOD score was obtained on chromosome 15q26, with a peak on marker D15S1014 (NPL=3.05), that reaches the statistical criteria for suggestive linkage (genomic P value of 0.07). In this region (15q26) mapped the gene ST8SIA2. Recently, two SNPs located in the promoter of the gene were reported in association with schizophrenia in a Japanese and Chinese sample. In order to test the frequencies of these polimorfisms, we performed a preliminary analysis in a sample of 156 Italian subjects: 56 patients and 100 healthy subjects (50 from Chioggia and 50 from other Italian regions). The SNPs analyzed resulted to be rare or not polymorphic at all, both in Chioggia and in the general Italian population, so they are unlikely to be directly involved in schizophrenia in our population. In order to test the possibility that some families share minor susceptibility loci not identified in the previous analysis, we evaluated linkage data for each single family separately. We found that 2 of the 16 pedigrees showed high LOD score values in 3q24-27 and 18q23, therefore in these regions a further investigations, increasing the marker density and analysing the haplotypes, were carried out. In this way, we were able to reveal on chromosome 3q24-27 a putative common haplotype shared between a subset of families. With a similar approach on chromosome 18q23 we were not able to identify a good segregation shared among other pedigrees. 4) Evaluate a possible involvement of mitochondrial polymorphisms in the pathogenesis of psychiatric disease. We characterized the mt haplogroups (Hg) and haplotypes (HVI region) of 86 index cases; the distribution of the Hg were similar to those reported for a large sample of the general Italian population so we were not able to find any significant differecies in the distribution of the haplogrups. Interestingly, we identified 12 lineages that seem to be shared between different families. These data suggest that: - families that share the same mtDNA could have a same maternal ancestor; - the shared mitochondria could carry a particular set of polymorphisms that influence the genetic predisposition to SZ and BPD.

Il testo ha lo scopo di fornire una panoramica piuttosto dettagliata sulle nuove tecnologie, basate su Intelligenza Artificiale, pensate per un impiego nell’ambito della salute mentale, ed in particolare per quanto riguarda l’autismo e la schizofrenia. La parte iniziale contiene una breve descrizione del problema della salute mentale, comprensiva di una breve descrizione dei disturbi dello spettro autistico e della schizofrenia. Segue un altrettanto breve descrizione dell’Intelligenza Artificiale e delle sue branche principali. Dopodiché, vengono descritte le principali soluzioni tecnologiche proposte negli ultimi anni in termini di prevenzione, diagnosi, monitoraggio dei pazienti e trattamento, che portano alla definizione di due nuovi concetti: digital phenotyping e digital interventions. Le recenti innovazioni tecnologiche in termini di smartphone e dispositivi indossabili hanno portato, inoltre, allo sviluppo di numerose applicazioni per la salute mentale, oltre che diversi altri strumenti quali chatbot, robot ed altri dispositivi indossabili. Infine, si conclude mettendo in evidenza gli attuali limiti di queste tecnologie, le implicazioni etiche derivanti dal loro impiego in medicina, e le prospettive per il prossimo futuro.

BACKGROUND: le caratteristiche cognitive e genetiche sono sempre più centrali nello studio della Schizofrenia. La compromissione delle Funzioni Esecutive (FE), definite come un complesso di abilità cognitive superiori attribuibili alle regioni della corteccia prefrontale, e della Facial Emotion Recognition (FER) rappresentano elementi centrali nel disturbo schizofrenico. Ad oggi, però, il paradigma del (dis)funzionamento cognitivo nella Schizofrenia poggia su studi che hanno escluso i soggetti schizofrenici con storia di abuso di sostanze (SUD), che ha mostrato un impatto peggiorativo sulla cognitività nella popolazione con disturbo da uso di sostanze. La letteratura ha inoltre negli anni definito polimorfismi potenzialmente implicati sia nella Schizofrenia sia nei disturbi da uso di alcol e sostanze, come quello (rs4680) relativo al gene della catecol-O-metiltransferasi (COMT). Viste la prevalenza del fenomeno e l’associazione fra cognition, outcome funzionale e le polimorfismi genetici, lo studio di tali correlati nei pazienti schizofrenici con abuso di sostanze costituisce una questione imprescindibile per una più puntuale stratificazione diagnostica, prognostica e dei trattamenti. SCOPO DEL LAVORO: valutare l’impatto del polimorfismo del COMT e dell’abuso di alcol e sostanze sulle performance cognitive in una popolazione di soggetti con schizofrenia. MATERIALI E METODI: si tratta di uno studio descrittivo­osservazionale. Sono stati reclutati 62 soggetti (M=50; F=12) con diagnosi di Schizofrenia secondo il DSM-IV (valutata attraverso la Structured Clinical Interview for DSM­IV, SCID I). Il campione è stato suddiviso a seconda della presenza o meno dell’abuso di alcol e sostanze correlato (valutato con l’Alcohol e la Drug Use Scale -AUS e DUS­) in due gruppi, che sono stati poi confrontati per quanto riguarda le caratteristiche socio­demografiche e cliniche (Positive and Negative Syndrome Scale - PANSS­). È stata analizzata quindi l’associazione tra condizione di abuso, polimorfismo del COMT e risultati ottenuti all’Intra-Extra Dimensional Set Shift (IED), che valuta le FE e il test di Ekman, che valuta la FER, controllando per variabili socio­demografiche e cliniche. RISULTATI: I due gruppi SKZ+SUD (n=28) e SKZ-SUD (n=34) presentano una differenza statisticamente significativa per età con media (SD) pari a 47.21 (9.41) negli abusatori e 36.04 (10.09) nei non abusatori (p<0.001). All’IED gli abusatori tendono a compiere meno errori (IED Total errors adjusted 47.32 (47.77) vs 70.59 (70.84); p=0.26), un minor numero di prove (IED Total trials adjusted 136.61 (85.65) vs 178.35 (128.02); p=0.24) per raggiungere il criterio necessario a superare gli stage e un maggior numero di stage completati (IED stages completed 7.79 (2.11) vs 6.85 (3.12); p=0.35) Al test di Ekman il gruppo degli abusatori (media=41.86 (7.50)) mostra un punteggio statisticamente più alto (p=0.02) rispetto ai non abusatori (media=35.29 (11.79). All’IED (stage completati), controllando per la PANSS, il genotipo Met-Met rispetto al genotipo Val-Val è diverso nel gruppo di abuso rispetto allo stesso confronto nel gruppo di non abuso (interazione con coefficiente -4.09 CI [-8.06, -0.13]; p=0.043): Met-Met mostra una performance peggiore rispetto a Val-Val nel gruppo di abuso. Lo stesso tipo di interazione è confermata anche per quanto riguarda il test di Ekman, pur non raggiungendo la significatività statistica (interazione con coefficiente -6.46 CI [-0.83, 13.76]; p=0.081). CONCLUSIONI: I soggetti schizofrenici con abuso si sono dimostrati tendenzialmente meno compromessi sotto il profilo neuropsicologico rispetto a quelli senza abuso. Inoltre si è evidenziata un’interazione tra il polimorfismo per il gene COMT e la condizione di abuso di alcol e sostanze per quanto riguarda le performance relative alle FE e alla FER.
BACKGROUND: cognitive and genetic features are increasingly important in the study of schizophrenia. The impairment of executive function (FE) and facial emotion recognition, are central issues in schizophrenic disease. To date, however, the paradigm of the (dis) cognitive functioning in schizophrenia is based on studies that excluded subjects with schizophrenia and a history of substance abuse (SUD)(5), which is actually a phenomenon that showed a derogatory impact on cognition in the population with substance use disorder. The literature has also over the years defined polymorphisms potentially implicated in both schizophrenia and in alcohol and substance use disorders, such as the one (rs4680) related to the gene of catechol-O-methyltransferase (COMT). Given the prevalence of the phenomenon and the association between cognition, functional outcome and genetic polymorphisms, the study of these related in schizophrenic patients with substance abuse is an important issue for a more precise stratification diagnosis, prognosis and treatment. AIM: to evaluate the impact of the COMT polymorphism and alcohol and substance abuse on cognitive performance in a population of subjects with schizophrenia. MATERIALS AND METHODS: this is a observational study. We recruited 62 subjects (M = 50, F = 12) diagnosed with schizophrenia according to DSM-IV (assessed by the Structured Clinical Interview for DSM-IV, SCID I). The sample was subdivided according to the presence or not of alcohol abuse and related substances (evaluated with the Alcohol and Drug Use Scale -Aus and DUS) into two groups (SKZ+SUD and SKZ-SUD), which were then compared with regard to socio-demographic and clinical characteristics (Positive and Negative Syndrome Scale - PANSS). It was then analysed the association between the condition of abuse, COMT polymorphism and score on Intra-Extra Dimensional Shift September (IED), which evaluates the FE and on test Ekman, evaluating the FER, controlling for socio-demographic and clinical variables. RESULTS: the two groups SKZ+SUD (n= 8) and SKZ-SUD (n = 34) show a statistically significant difference by age with mean (SD) of 47.21 (9.41) in abusers and 36.04 (10.09) in non-abusers (p <0.001). Abusers tend to make fewer errors on IED (IED errors adjusted Total 47.32 (47.77) vs 70.59 (70.84); p = 0:26), fewer trials (IED trials Total Adjusted 136.61 (85.65) vs 178.35 (128.02); p = 0:24) to reach the criterion to overcome the stage and a greater number of stages completed (IED stages completed 7.79 (2.11) vs 6.85 (3.12), p = 0:35). Abusers (mean = 41.86 (7:50)) show a score statistically higher (p = 0.02) compared with non-abusers (mean = 35.29 (11.79) on Ekman test. On IED (stage completed), checking for the PANSS, the Met-Met genotype compared with Val-Val genotype was different in the group of abuse compared with the group not abusing (interaction coefficient -4.09 CI [-8.06, -0.13]; p = 0.043): Met-Met show a worse performance than in the group of Val-Val. The same type of interaction is confirmed also with regard to the Ekman , although not reaching statistical significance (interaction with coefficient -6.46 CI [-0.83, 13.76]; p = 0.081). CONCLUSIONS: subjects with schizophrenia and substance abuse seems to be less compromised from a neuropsychological point of view than those without abuse. Furthermore it is shown an interaction between the polymorphism for COMT gene and the condition of alcohol and substance abuse with regard to the FE and FER performance.

Per molti anni, gli studi sulla percezione degli input sensoriali si sono concentrati su come le informazioni venissero codificate, filtrate ed elaborate dalle singole modalità; tuttavia, le informazioni provenienti dal mondo che ci circonda, non attivano una singola modalità sensoriale, ma molteplici modalità. Negli ultimi decenni, gli studi riguardanti i processi sensoriali hanno subito un cambio di direzione, analizzando come le informazioni vengano processate da una rete neurale multisensoriale, dinamica, capace di mettere in relazione le diverse aree del cervello deputate all’elaborazione delle informazioni provenienti dalle diverse modalità sensoriali. La schizofrenia (SCZ) e il disturbo dello spettro autistico (ASD) sono due complesse patologie neurocognitive; entrambe caratterizzate da disturbi sociali, comunicativi e comportamentali. Diversi studi degli ultimi decenni hanno dimostrato che nei soggetti affetti da ASD e SCZ, la capacità di integrare informazioni multisensoriali, ovvero informazioni che provengono da più modalità sensoriali, è ridotta rispetto ad un soggetto normotipico, ossia un individuo le cui capacità intellettive e neurologiche possano esser considerate nella norma. In questo elaborato, in seguito ad un approfondimento sui processi multisensoriali e sulle caratteristiche cliniche di ASD e SCZ, sono stati presentati studi comportamentali ed esaminati i risultati ottenuti. Inoltre, sono state analizzate le caratteristiche di un modello matematico basato su una rete neurale in grado di simulare il processo di elaborazione multisensoriale: il modello include connessioni tra due regioni unisensoriali, a loro volta connesse con una regione multisensoriale. Attraverso questo modello viene simulata l’integrazione e l’elaborazione multisensoriale, sia a livello unisensoriale che a livello multisensoriale con l’obbiettivo di comprendere i meccanismi neurobiologici e le differenze neurali tra i soggetti normotipici e i soggetti ASD e SCZ.

Efter psykiatrireformen i mitten av 1990-talet övergick Sverige från den tidigare institutionsbaserade vården till den idag kommunbaserade vården. Vi som vårdare kan nu träffa på människan med schizofren sjukdom var vi än jobbar, då människan med schizofren sjukdom även får kroppsliga sjukdomar. Schizofreni är en sjukdom som ofta innefattar en värld som kan upplevas främmande, svår att förstå och långt ifrån den livsvärld vi som vårdare vanligtvis möter. Om förståelsen hos oss som vårdare brister i hur människan med schizofren sjukdom upplever sin livsvärld kan det påverka bemötandet och vården negativt. För att kunna ge ett värdigt och respektfullt bemötande behövs kunskap och förståelse om hur människan med schizofren sjukdom upplever sin livsvärld och mötet i vården.Syftet med litteraturstudien är att belysa hur människan med schizofren sjukdom upplever sin livsvärld och mötet i vården. Tre biografier skrivna av människor som själva har upplevt schizofreni har använts som grund för analys, enligt Fribergs (2006) modell för att analysera berättelser (narrativer). I diskussionen av studiens resultat har även fem stycken artiklar använts som grund för diskussion.Resultatet har delats in i åtta olika kategorier, upplevelsen av: den andra världen, mellan världar, rädsla för förändrad identitet, negativ identitet, negativa röster, positiva röster, dålig vård, bra vård.I diskussionen diskuteras den för studien valda metoden och fynden från analysen tillsammans med de fem artiklar som ligger till grunden för diskussionen.

Program: Sjuksköterskeutbildning

Uppsatsnivå: C

La tesi si è focalizzata sullo studio del comportamento violento in pazienti con una diagnosi di Disturbo dello Spettro Schizofrenico (DSS) e una storia di violenza, appaiati a dei controlli. Il protocollo ha incluso anche un periodo di osservazione di un anno. Il progetto di ricerca è stato condotto in alcune strutture residenziali (studio 1) e presso alcuni Centri di Salute Mentale (studio 2) del nord Italia, con gli obiettivi di: (i) analizzare le caratteristiche socio-demografiche, cliniche e neuropsicologiche di pazienti con DSS e una storia di violenza comparati a pazienti con DSS, senza tale storia, appaiati per genere ed età; (ii) quantificare i comportamenti violenti esibiti dai pazienti con DSS durante un anno di osservazione, e identificarne i possibili fattori protettivi e di rischio; (iii) caratterizzare i pazienti con DSS che hanno esibito condotte particolarmente violente durante l’anno di osservazione. I risultati mostrano specifiche condizioni cliniche e di funzionamento cognitivo caratterizzanti i pazienti con storia di violenza, ed evidenziano diversi fattori associati all’esibizione di comportamenti violenti nei due servizi.
This thesis addresses the phenomenon of violence by patients with Schizophrenia Spectrum Disorders (SSDs) who had a history of violence, compared to matched controls. The research protocol also included a 1-year observation period. The research project has been carried out in ordinary psychiatric residential facilities (study 1) and in Community Mental Health Centres (study 2) in northern Italy. The aims were: (i) to investigate the demographic, clinical, and neurocognitive features of patients with SSDs who had a history of violence, matched by age, gender and diagnosis to controls; (ii) to quantify violence exhibited by patients with SSDs during 1 year, and to identify protective and risk factors for such violence; (iii) to characterize patients exhibiting considerable violence during the study period. The results of the project show different clinical and cognitive characteristics for patients with a history of violence and for controls, and different factors associated with violence exhibited in the two care settings.

La tesi si è focalizzata sullo studio del comportamento violento in pazienti con una diagnosi di Disturbo dello Spettro Schizofrenico (DSS) e una storia di violenza, appaiati a dei controlli. Il protocollo ha incluso anche un periodo di osservazione di un anno. Il progetto di ricerca è stato condotto in alcune strutture residenziali (studio 1) e presso alcuni Centri di Salute Mentale (studio 2) del nord Italia, con gli obiettivi di: (i) analizzare le caratteristiche socio-demografiche, cliniche e neuropsicologiche di pazienti con DSS e una storia di violenza comparati a pazienti con DSS, senza tale storia, appaiati per genere ed età; (ii) quantificare i comportamenti violenti esibiti dai pazienti con DSS durante un anno di osservazione, e identificarne i possibili fattori protettivi e di rischio; (iii) caratterizzare i pazienti con DSS che hanno esibito condotte particolarmente violente durante l’anno di osservazione. I risultati mostrano specifiche condizioni cliniche e di funzionamento cognitivo caratterizzanti i pazienti con storia di violenza, ed evidenziano diversi fattori associati all’esibizione di comportamenti violenti nei due servizi.
This thesis addresses the phenomenon of violence by patients with Schizophrenia Spectrum Disorders (SSDs) who had a history of violence, compared to matched controls. The research protocol also included a 1-year observation period. The research project has been carried out in ordinary psychiatric residential facilities (study 1) and in Community Mental Health Centres (study 2) in northern Italy. The aims were: (i) to investigate the demographic, clinical, and neurocognitive features of patients with SSDs who had a history of violence, matched by age, gender and diagnosis to controls; (ii) to quantify violence exhibited by patients with SSDs during 1 year, and to identify protective and risk factors for such violence; (iii) to characterize patients exhibiting considerable violence during the study period. The results of the project show different clinical and cognitive characteristics for patients with a history of violence and for controls, and different factors associated with violence exhibited in the two care settings.

Introduzione. Negli ultimi anni c'è stato un crescente interesse sulla sindrome metabolica (MetS) e sul ruolo che questa può ricoprire nell’aumentare il rischio di mortalità cardiovascolare tra i soggetti affetti da disturbo mentale grave (SMI). Obiettivi. L’obiettivo primario di questo studio è la stima del rischio tra soggetti affetti da SMI, rispetto ad individui che ne sono privi, di essere affetti da MetS. Metodi. (1) Revisione sistematica e meta-analisi: La revisione sistematica e meta-analisi è stata realizzata seguendo i criteri del MOOSE e del PRISMA Statement. Sono stati utilizzati PubMed e Embase come database per la ricerca. Sono stati inclusi tutti gli studi in cui fossero presenti dati di prevalenza di MetS in un gruppo di soggetti affetti da SMI e in un gruppo di controllo privo di patologia psichiatrica. (2) Studio trasversale comparativo: Lo studio è stato effettuato tra marzo 2011 e febbraio 2012 presso l’Azienda Ospedaliera Universitaria San Gerardo di Monza. Un campione randomizzato di individui affetti da SMI e un gruppo di controllo adeguato privo di tale disturbo sono stati reclutati per la valutazione della prevalenza di MetS, sulla base dei criteri NCEP ATP III, e delle caratteristiche correlate. Risultati. (1) Revisione sistematica e meta-analisi: Sulla base dei criteri di inclusione, 27 articoli sono stati inclusi per la meta-analisi. Il pooled OR di MetS in soggetti affetti da SMI era 1.95 [1.54, 2.47], con un’elevata eterogeneità tra gli studi (I2 = 87%). Gli studi selezionati presentavano tuttavia numerose criticità dal punto di vista della qualità e del rischio di bias. (2) Studio trasversale comparativo: Abbiamo rilevato una prevalenza del 26.1% di MetS nel gruppo SMI e del 15.9% nel gruppo di controllo. L’analisi multivariata ha evidenziato come soggetti affetti da SMI avessero una probabilità di essere affetti da MetS oltre quattro volte superiore rispetto al gruppo di controllo. Conclusioni. I risultati della meta-analisi e dello studio trasversale comparativo convergono nel rilevare una maggiore probabilità di MetS in soggetti affetti da SMI. Prevenzione, diagnosi, monitoraggio e trattamento dei disturbi metabolici dovrebbero diventare parte integrante della gestione a lungo termine dei pazienti affetti da SMI da parte dei clinici. La ricerca futura dovrebbe concentrarsi (1) sul contributo relativo dello stile di vita, di fattori genetici e altre possibili variabili associate, come la terapia con farmaci antipsicotici, sul rischio di MetS e (2) sull’efficacia degli interventi volti alla promozione della salute tra individui affetti da SMI.

This study aimed at investigating the relationship between cognition, Metabolic Syndrome and inflammation in a sample of patients with schizophrenia, also investigating in a subsample possible influences of Metabolic Syndrome and related inflammatory biomarkers on white matter integrity and brain metabolites of the Dorsolateral Prefrontal Cortex.
Obiettivo di questo studio è l'analisi del rapporto tra deficit cognitivo, Sindrome Metabolica e infiammazione in un campione di pazienti affetti da schizofrenia, analizzando inoltre all'interno di un sottocampione possibili influenze della Sindrome Metabolica e dei suoi biomarker infiammatori sull'integrità della sostanza bianca e i neurometaboliti della corteccia Dorsolaterale Prefrontale

La schizofrenia è una psicopatologia caratterizzata da sintomi psicotici prominenti. Sebbene dopo oltre 100 anni di ricerche le cause della malattia risultino ancora sconosciute, alcune recenti teorie hanno evidenziato il possibile ruolo di una sindrome di disconnessone e/o di un disturbo nella coordinazione dinamica. Pertanto, i meccanismi che mediano la generazione di attività coerenti e coordinate nei circuiti corticali sono fra i principali candidati per comprendere la psicosi in esame. Le oscillazioni neurali sono un meccanismo fondamentale per permettere il coordinamento delle attività durante il normale funzionamento cerebrale e sono perciò un punto fondamentale su cui si basano le attuali ricerche sulla schizofrenia. Questo elaborato ha l’obiettivo di evidenziare il ruolo che alterazioni delle oscillazioni neurali possono rivestire nella genesi della schizofrenia, tramite la revisione delle evidenze provenienti da diversi studi (tra cui il recente di Adams, pubblicato nell’aprile 2020) e di esaminare, inoltre, le possibili cause neurobiologiche delle onde neurali anomale, quali deficit nell’attività degli interneuroni GABAergici.

Questa ricerca si propone di studiare i correlati neuro-autonomici delle alterazioni del funzionamento sociale che caratterizzano il Disturbo Borderline di Personalità (DBP) e la Schizofrenia. Nel DBP tali difficoltà riflettono un’organizzazione disfunzionale del sé; nella Schizofrenia, invece, sembrano dipendere dalla sintomatologia difettuale. La teoria polivagale fornisce una cornice teorica per comprendere se tali alterazioni si associno a strategie di regolazione autonomica che favoriscono comportamenti difensivi. Secondo la teoria polivagale, la reattività alle “sfide” ambientali dipende, a livello cardiaco, da tre branche del Sistema Nervoso Autonomo, sviluppate consecutivamente nel corso dell’evoluzione, alternativamente attivabili: (1) il sistema vagale non mielinizzato, responsabile della riduzione della frequenza cardiaca e di comportamenti di immobilizzazione, (2) il sistema nervoso simpatico, che determina tachicardia e risposte di “attacco-fuga”, e (3) il sistema vagale mielinizzato, che si attiva in modo flessibile in base alla presenza di minacce nell’ambiente e favorisce un coinvolgimento sociale adattivo. L’impatto dinamico delle fibre vagali mielinizzate sul cuore può essere misurato con l’Aritmia Sinusale Respiratoria (ASR), un’oscillazione spontanea del ritmo cardiaco in base agli atti respiratori. Nel primo studio, usando il paradigma sperimentale Cyberball, sono stati valutati i cambiamenti di ASR in condizioni di inclusione sociale ed ostracismo nei pazienti affetti da DBP, confrontandoli con un gruppo di Controlli Sani (CS) e con pazienti affetti da Disturbo Depressivo Maggiore Ricorrente in fase di remissione, inclusi come gruppo clinico di controllo. I pazienti affetti da DBP presentavano una ridotta ARS, indice di uno stato fisiologico che predispone a comportamenti difensivi già nell’approccio all’interazione sociale. Durante il gioco i pazienti affetti da DBP hanno presentato un’ulteriore riduzione dei livelli di ARS, che indica uno stato di allarme persistente, indipendente dal tipo di interazione, associato a maggiori sentimenti di minaccia anche in contesti sociali favorevoli. Nel secondo studio le risposte autonomiche ed emotive al gioco Cyberball sono state valutate in un gruppo di pazienti affetti da Schizofrenia, confrontandoli con un gruppo di CS. I pazienti, in condizioni di riposo, mostravano ridotti livelli di ARS, espressione di una ridotta flessibilità fisiologica in potenziali interazioni sociali. Nella condizione di ostracismo hanno riportato una minore percezione di minaccia rispetto ai CS e non hanno sviluppato tendenze aggressive verso i partecipanti da cui erano stati esclusi. In entrambi i gruppi non è stata rilevata alcuna modulazione nell’ARS, ad indicare che nel corso dell’interazione sociale il “freno vagale” ha soppresso l’attivazione di potenziali risposte di attacco/fuga. Tali risultati confermano che ridotti livelli di ARS a riposo si osservano in modo trans-diagnostico in diversi disturbi psichici. I cambiamenti in ARS in risposta all’interazione sociale sembrano essere distintivi del DBP. Il terzo studio riguarda l’enterocezione, intesa come la percezione delle sensazioni interne al corpo. Il processamento dei segnali enterocettivi è stato correlato a funzioni psicologiche superiori quali il senso di sé e la regolazione emotiva. Un recente studio ha mostrato come tali processi siano associati alla capacità di regolazione autonomica nei contesti sociali. L’Accuratezza Enterocettiva (AE) è stata misurata con il task di detenzione dei battiti cardiaci, sul campione aggregato. I risultati hanno mostrato una ridotta AE nei pazienti affetti da DBP e Schizofrenia, suggerendo un possibile effetto di mediazione dei processi enterocettivi nelle alterazioni del funzionamento sociale.
This research aims to study the neuro-autonomic correlates of the impairment in social functioning, found as a core component of at least two psychiatric disorders, namely Borderline Personality Disorder (BPD) and Schizophrenia. Whereas in the former the impairment in social functioning reflects a disturbed psychological self-organization, in the latter it seems to be most related with deficit syndrome symptoms. The polyvagal theory provides a theoretical framework to explore whether these compromised social functioning would be associated with autonomic regulation strategies that foster defensive and non-social behaviours. According to the polyvagal theory the physiological reactivity in response to environmental “challenges” depends, at the cardiac level, on three branches of the Autonomic Nervous System. These could be alternatively dominant and have consecutively developed during evolution as follow: (1) the un-myelinated vagal system, associated with cardiac slowing and “freezing” conducts, (2) the sympathetic nervous system, responsible for tachycardia and “fight or flight” responses, and (3) the myelinated vagal system, that acts in different ways according to the estimated threat in the environments and fosters adaptive social engagement. The dynamic impact of the myelinated vagal fibers on the heart is reflected by the amplitude of the Respiratory Sinus Arrhythmia (RSA), a naturally occurring rhythm in the cardiac cycle at approximately the frequency of spontaneous breathing. In the first study, using the Cyberball experiment, we investigated whether BPD patients display a peculiar pattern of changes in RSA after conditions of social inclusion and ostracism, compared with Healthy Controls (HC) and remitted Major Depressive Disorder patients, as a clinical control group. We found that, before the task, BPD patients showed reduced resting RSA, indicating stable difficulties in social predisposition. During the task, BPD patients responded with greater physiological arousal to any social situation and with greater feelings of ostracism after actually benign social scenarios, i.e., following social inclusion and when the ostracism experience is over. In the second study, we measured the autonomic and psychological response to Cyberball in a sample of patients with Schizophrenia, compared with HC. At baseline, we observed a reduced resting RSA, index of impaired social flexibility. During the task, the patients with Schizophrenia showed a blunted perception of threat and did not report aggressive tendencies, compared to HC, in response to the condition of ostracism. In both samples, a parasympathetic withdrawal was not observed, showing that the experience of being excluded did not induce propensities toward fight/flight responding. Overall, these findings confirmed low resting RSA that was observed across a variety of trans-diagnostic psychiatric conditions. Moreover, our results suggest that phasic changes in RSA in response to social interaction could be a trait marker of BPD. Finally, in the third study, we investigated the interoception, conceptualized as the sense of the internal physiological condition of the body. The processing of afferent bodily signals has been linked to higher-order psychological functions such as the sense of self and emotions regulation. Specifically, recent evidence suggested that interoceptive processes might predict the autonomic regulation in a social setting. Interoceptive Accuracy (IA) was measured with a heart beat detection task in the aggregated sample. Our results showed a reduced IA among patients with both BPD and Schizophrenia, confirming how interoceptive processes are altered in clinical samples and should be considered as potential mediator in patients' psychosocial difficulties.

The presented thesis attempts to find the adequate ways to express the specific disorders of schizophrenia cinematically via the study of the illness on the psychological basis. Studying the diverse layers of the schizophrenic personality such as thinking, concentration, memory, perception and cognitive and perceptive processes, it tries to find the causes of the specific disorders. It also defines the state caused by these and later it focuses on the procedures (audiovisual fragments, editing, dramaturgy etc.) which could cinematically transfer the audience inside the head of the schizophrenic. It especially focuses on the hallucinations and their dramaturgic potential. When certain rules are preserved, the hallucination provides an instrument giving the infinite possibilities of slipping on the border between the real and the unreal. Therefore, it exceeds the framework of this thesis towards the general cinematic speech.

Schizofreni är en allvarlig, psykisk sjukdom med mentala störningar och förlust av kontakt med verkligheten. Sjukdomen påverkar hela personens livssituation. Syftet med denna litteratur studie var att beskriva hur det är att leva med schizofreni. Metoden som används var en litteraturstudie. En samlingsnovell med patientens berättelse och tre självbiografier av människor som själv upplevd schizofreni har analyserats samt en roman av en författare som var i nära kontakt med en schizofren patient. De analyserades enligt Lyckhage modellen för att analysera berättelser. Sju kategorier har framkommit i resultaten som uttrycks med: Leva i en främmande och ond värld, Självmord, Relation till vårdpersonalen, Familjen och närstående, Självuppfattning, Att uppleva ångestattacker, samt Inre röster och hallucinationer.

Schizophrenia is a serious psychological disease with mental disorder and loss of reality. The disease affects the whole life situation for the individual. The aim with this literature review was to describe how it is to live with schizophrenia. The method that is used is literature studies which means that a collection of different patients´ stories, three biographies written by people who themselves have experienced schizophrenia have been analysed but also a novel written by an author who was in close relation with a schizophrenic patient. These materials have been analysed according to Lyckhage´s model for analysing stories. Eight categories have emerged in the result giving utterance to: To live in an alien and evil world, suicide, relation to the nursing staff, family and relatives, self-concept, experiencing anxiety attacks, and inner voices and hallucinations.

Il seguente lavoro di tesi indaga il senso di ownership e di agency in schizofrenia come modalità per approfondire i meccanismi di consapevolezza del sé in questi pazienti. Basandoci su studi precedenti che evidenziano disturbi del senso di agency e deficit di integrazione sensorimotoria, abbiamo condotto tre studi finalizzati ad esplorare il riconoscimento del proprio corpo servendoci di un’illusione corporea visuo-motoria, i.e., la Mirror Box illusion. Il paradigma è utile al fine di elicitare sensazioni di agency e ownership durante l’incorporazione illusoria di una mano aliena in movimento. Nell’Esperimento 1 è stato investigato l’effetto della congruenza temporale tra il feedback visivo (la mano di uno sperimentatore riflessa nello specchio) e il feedback propriocettivo (la mano del partecipante) sulle misure esplicite ed implicite dell’illusione (il questionario di embodiment e il compito di bisezione del braccio). I partecipanti sani presentano una modulazione significativa del senso di ownership, del senso di agency e dalla stima di bisezione in accordo col grado di congruenza visuo-motoria esperita durante l’illusione. Senso di agency e stima di bisezione non modulano invece nei pazienti. Abbiamo ipotizzato che due meccanismi potrebbero spiegare i risultati ottenuti nel gruppo di pazienti: una finestra di integrazione temporale visuo-propriocettiva ampia e/o un deficit a livello di copia efferente del comando motorio. Il secondo esperimento è stato pianificato al fine di dissociare il contributo relativo di ciascuno dei due meccanismi ipotizzati. Nell’Esperimento 2 i partecipanti dovevano eseguire movimenti attivi vs. passivi mentre un ritardo gradualmente maggiore veniva inserito tra l’input visivo e l’input propriocettivo tramite un’apposita apparecchiatura. Dalle analisi preliminari emerge un’alterata modulazione del senso di ownership nei pazienti, la quale sembra essere maggiormente dovuta ad un’aumentata finestra di integrazione sensoriale. Questo risultato potrebbe indicare che un’alterazione a livello di integrazione delle afferenze sensoriali potrebbe essere maggiormente implicata nell’alterazione del senso di ownership. Tale conclusione è tuttavia da considerarsi provvisoria data la scarsa numerosità del gruppo di pazienti. In ultimo, l’Esperimento 3 costituisce un’analisi esplorativa dei confini spaziali dell’illusione al fine di testare l’ipotesi relativa all’estrema malleabilità della rappresentazione corporea in schizofrenia. Basandosi su quest’ipotesi, è possibile che i pazienti siano maggiormente predisposti ad incorporare una mano aliena posizionata ad una distanza anatomicamente implausibile dal loro corpo. Abbiamo inizialmente condotto uno studio per verificare in che misura un’elevata discrepanza visuo-propriocettiva sia in grado di inibire il senso di ownership per la mano aliena in un gruppo di partecipanti sani. Utilizzando la stessa apparecchiatura dello studio precedente abbiamo ottenuto risultati solo parzialmente in accordo con l’ipotesi poichè il senso di ownership diminuisce a livello esplicito, ma non a livello implicito. Altro lavoro di ricerca basato su altre manipolazioni sperimentali potrebbe consentire di capire se i risultati ottenuti siano dovuti al compito utilizzato oppure ad una maggior sensibilità della valutazione soggettiva del senso di ownership a questo tipo di manipolazioni. In conclusione, il presente lavoro mostra che i deficit di integrazione visuo-motoria in schizofrenia non impattano solo sul senso di agency, ma anche sul riconoscimento del proprio corpo. Questi risultati espandono i risultati precedentemente osservati negli studi di Rubber Hand illusion, portando evidenza empirica rispetto al fatto che i disturbi di percezione corporea in schizofrenia potrebbero essere dipendenti da processi di integrazione sensorimotoria deficitari.
The present thesis addresses the build-up of the senses of agency and ownership in schizophrenia, as a clue to understand the mechanisms of self-awareness in these patients. Based on previous literature highlighting disturbances of sense of agency and impairments in sensorimotor integration, we carried out a series of three studies aimed to explore self-body recognition by capitalizing on a visuomotor body illusion, i.e. the mirror box illusion. This paradigm was useful in order to elicit overt sensations of agency and ownership under condition of illusorily embodiment of a moving alien hand. In Experiment 1, the effect of temporal congruency between visual (experimenter’s hand reflected in the mirror) and the proprioceptive (participant’s hand) input on subjective and objective measures (namely, embodiment questionnaire and forearm bisection task) of the illusion was addressed in 36 healthy participants and 29 patients affected by schizophrenia. In healthy participants, sense of agency, sense of ownership and bisection performance modulate in accordance to the extent of visuo-proprioceptive synchrony. By contrast, the sense of agency and bisection performance did not significantly vary across conditions in patients. Such results indicate that impaired sensorimotor processes, as testified by previous work on self-attribution task, may explain the altered modulation of embodiment in the schizophrenia group. We hypothesized that two sensorimotor mechanisms might be implicated, namely a widened visuo-proprioceptive TBW and a disruption of efference-related signals. In order to help disentangling the role of these two mechanisms, the second experiment was designed. In Experiment 2, participants were asked to perform active vs. passive movements, while increasing time-lags between the visual and the proprioceptive input were introduced using a custom-made mirror box setting. A sample of 32 healthy controls and 18 patients with schizophrenia was recruited. Preliminary analyses show an altered modulation of the illusorily sense of ownership in patients, which is mostly accounted for by an enlarged visuo-proprioceptive temporal binding window. This result might indicate that an abnormal integration of afferent signals is strongly involved in the disruption of self-body ownership in schizophrenia. This conclusion, however, warrants caution given the small size of the patients group. Finally, Experiment 3 represents an exploratory study to test the hypothesis of abnormal malleability of body representation in schizophrenia derived from the literature on rubber hand illusion in schizophrenia. Based on this assumption, it could be expected that patients are abnormally prone to embody an alien hand positioned at an anatomically implausible distance from the body. In order to address this issue, we first sought to verify to what extent high spatial visuo-proprioceptive discrepancy can inhibit the sense of ownership for a moving alien hand in healthy people. Using the same mirror box setting previously mentioned, we obtained results that are only partially in agreement with the hypothesis, since illusory ownership deems to decreases only at a subjective, but not objective level. Further work, using a different experimental manipulation, might better address whether these results may be due to the task used or to the higher sensitivity of subjective assessment of body ownership to this kind of manipulation. In conclusion, the present work demonstrates that putatively impaired visuo-motor integration processes in schizophrenia do not only impact on the sense of agency, but also on the recognition of one’s own body. These findings expand previous work based on the rubber hand illusion, providing empirical evidence of the fact that disturbances of body perception in schizophrenia can be dependent on defective sensorimotor processes for action.

Bakgrund: Idag finns det cirka 40 000 individer som har diagnosen schizofreni i Sverige. Schizofreni innebär psykisk ohälsa i form av bland annat hallucinationer, vanföreställningar samt apati och passivitet, vilket leder till en försämrad livskvalitet. Syfte: Syftet med litteraturstudien var att belysa upplevelsen av livskvalitet hos patienter med diagnosen schizofreni. Metod: Studien utfördes som en allmän litteraturstudie där sju vetenskapliga artiklar, som var relevanta till syftet, valdes ut, kvalitetsgranskades och analyserades. Resultat: Resultatet delades in i fem olika rubriker. Det visade sig att svåra symtom, civilstatus, socialt nätverk, otillfredsställda behov och ekonomi alla vara direkt relaterade till livskvaliteten hos patienter med schizofreni. Slutsats: Förbättrade levnadsförhållanden betyder inte nödvändigtvis förbättrad livskvalitet. Många faktorer bland annat trygg och lugn omgivning, bra ekonomi och ett bra socialt nätverk påverkar livskvaliteten. Därför bör sjukvårdspersonal tillgodose patienternas behov på ett adekvat sätt och därmed bidra till en förbättrad livskvalitet.

Background: About 40 000 individuals in Sweden lives with the diagnose schizophrenia. Schizophrenia involves psychiatric disease with symptoms such as hallucinations, delusions, apathy and passivity, which lead to a decline in quality of life. Purpose: The purpose of the study was to elucidate the experience of quality of life in patients with schizophrenia. Method: The study was conducted as a literature review where seven scientific articles were chosen, critically reviewed and analysed. Result: The result was divided in to five different categories. Severe symptoms, marital status, social network, unmet needs and economy appeared to be all directly related to quality of life in patients with schizophrenia. Conclusion: Improved living conditions do not necessarily improve quality of life. Many factors including security, quiet environment, good economy and a good social network affects the quality of life. Therefore, health care professionals should meet patient needs in an adequate manner and thus contribute to an improved quality of life.

Abstrakt

Bakgrund: Schizofreni är en av de vanligaste orsakerna till att man drabbas av en psykos. Det är för det mesta unga människor som insjuknar. Patienter med schizofreni har oftast bristfällig insikt och förståelse för sin sjukdomsbild och behandling. Utbildning och rehabilitering är därför fokuserad på att öka patienters självständighet. Detta har visat att risken för återfall minskar vilket i sin tur bidrar till ett ökat välmående och förbättrade sociala förmågor.

Syfte: Syftet med denna litteraturstudie var att göra en replikation på SBU:s rapport från 1999 omvårdnad vid schizofreni och belysa faktorer som påverkar omvårdnaden vid schizofreni.

Metod: Det gjordes en systematisk litteraturstudie som baserades på 20 vetenskapliga artiklar. Artiklarna bedömdes först enskilt och sedan tillsammans enligt granskningsmall från SBU. Kvalitén bedömdes utifrån en tregradig skala och de artiklar som användes uppfyllde kriteriet för hög till medelhög kvalité.

Resultat: Patienter med schizofreni och deras anhöriga upplevde många svårigheter socialt, emotionellt och ekonomiskt. Sjuksköterskans viktigaste uppgift var att identifiera de omvårdnadsbehov som patienterna och deras anhöriga hade, så att de kunde få rätt stöd och omvårdnadsåtgärd.

Diskussion: För att en omvårdnadsrelation skall kunna utvecklas är det viktigt att sjuksköterskan är flexibel. Genom att ha en öppen hållning, vara förstående och lyssna kan man ta del av personens livsvärld och lättare kunna identifiera de specifika vårdbehoven. Det viktiga är att se varje individ som unik med olika förutsättningar och behov för att kunna ge bästa möjliga omvårdnad.

SANTRAUKA Šizofrenija sergančių asmenų socialinės adaptacijos resursai Psichikos sutrikimų našta visuomenei nuolat auga, netgi pradeda vyrauti, palyginti su kitais sveikatos sutrikimais. Šizofrenija yra viena sudėtingiausių psichikos ligų. Pažeista socialinė adaptacija yra vienas iš šizofrenijos požymių. Liga pažeidžia santykius šeimoje, sutrinka ir profesinė, akademinė veikla. Žmogus dažnai tampa diskriminuojamas visuomenėje, nes pati psichikos ligos diagnozė yra savotiška stigma. Svarbu ištirti šizofrenija diagnozuotų asmenų stipriąsias puses, tiek vidinius, tiek išorinius jų resursus, kuriuos atradus galima būtų kryptingai panaudoti sėkmingai jų socialinei adaptacijai. Darbas susideda iš dviejų dalių: teorinės ir empirinės. Teorinėje darbo dalyje aptariami pagrindiniai šizofrenijos simptomai ir jų pasekmės. Analizuojama, kokią įtaką šizofrenija turi sergančiųjų socialiniai adaptacijai atsižvelgiant į tris aspektus: šeima, darbas, visuomenė. Pristatoma į stiprybes orientuotos perspektyvos koncepcija, resursų reikšmė socialinei adaptacijai. Pagrindinis tyrimo tikslas – atskleisti šizofrenija sergančių asmenų resursus sėkmingai socialinei adaptacijai. Tyrime dalyvavo 3 šizofrenija diagnozuoti asmenys, atrinkti pagal iš anksto nustatytus kriterijus. Kokybiniam tyrimui atlikti buvo naudojamas pusiau struktūruoto naratyvinio interviu metodas. Nors kiekvieno kliento atvejis yra unikalus, tačiau apibendrinant tyrimo rezultatus galima teigti, kad ligos pradžioje šizofrenija... [toliau žr. visą tekstą]
SUMMARY Resources of Social Adaptation of People Ill with Schizophrenia Mental diseases of human psyche have overburdened our society becoming predominant than any other health disorder. Schizophrenia is one of the most complex mental diseases. The failure of social adaptation to the environment is one of the major symptoms of schizophrenia. This mental disease causes a negative effect on family relationships as well as produces damage on the human ability to perform professional activities. A diagnosis of schizophrenia is like a certain stigma to a person because such individuals tend to be discriminated in their society. It is of great importance to analyze and discover the strongest positive internal and external resources of the individual diagnosed with schizophrenia as this could provide the opportunity to offer effective professional help to a person overcoming the problems of social adaptation. The Paper is divided in two parts: theoretical and empirical one. The Theoretical part introduces the main symptoms of schizophrenia and demonstrates the consequences of the disease on individual. Moreover, the Paper analyzes the influence of schizophrenia on individual as a social being concentrating on three major aspects: family life, work and society. The conception of strength-based perspective has also been introduced as well as the importance of positive resources to social adaptation. The main aim of the research is to reveal the positive resources of the individual... [to full text]

PURPOSE: To determine the effect of schizophrenia on patient handwriting and to catalogue handwriting deformities typical of schizophrenic graphism. The additional purpose is to explore and ascertain whether the self-inspired handwriting samples of schizophrenic patients contain language phenomenons typical of schizophasia. METHOD: Two study groups were recruited for the handwriting analysis, each of them comprising 30 subjects. The patient group consisted of subjects diagnosed with schizophrenia, according to the behavioural criteria outlined in ICD-10. All they have been treated by the specialist psychiatrist for a relatively long time and have been receiving neuroleptic treatment for at least 5 years. The collected handwriting samples were provided by the individuals diagnosed with schizophrenia: women (age range 3050 years) and men (age range 30-55 years). The precise diagnoses in this study groups included paranoid schizophrenia (17 subjects), simple schizophrenia (11 subjects) and undifferentiated schizophrenia (2 subjects). Therefore, the collected study material encompassed 30 handwriting samples of 15 men and 15 women. The mean age of subjects in the study group was approx. 44.6 years, with the mean age in the women subgroup of approx. 45 years and the mean age in the men subgroup of approx. 44 years. In order to conduct the comparative analysis of graphism traits in patients with schizophrenia, the handwriting samples were also collected from the control group, consisting of 30 healthy individuals, who never used any mental health care provisions before and did not present with any detectable mental abnormality. The controls were matched to the subjects in terms of sex, age and level of education. Eventually, the material provided by 30 individuals (15 women and 15 men) was analysed, with the mean age in the women subgroup of approx. 43 years and the mean age in the men subgroup of approx. 55 years. Two types of written samples were collected: Same content samples - all subject were requested to write down two stanzas and a chorus of Polish national anthem. The study samples enabled the author to analyse the effect of schizophrenia on the handwriting thus allowing the attempt to determine what the handwriting traits of schizophrenia sufferers are. Non-subject-specific, free piece of handwriting, requested only from the individuals diagnosed with schizophrenia. The analysis of this handwriting sample was meant to detect the mental state alterations, such as impaired judgement and conclusion, with particular emphasis on delusional attitudes. Based on the handwriting variable system and guided by the operational definitions of the variables provided by T. Widła, the analysis of 29 specific variables and 178 corresponding sub-variables was performed. These pertained to four aspects of graphism, namely its structure (form), alignment, as well as the form and degree of connection. Both study groups were included in this test – the experimental group composed of subjects diagnosed with schizophrenia and the control groups composed of healthy individuals. In the author's opinion, it is only the comparative research, including the control group consisting of healthy individuals without the obvious signs and symptoms of schizophrenia, to enable the actual comparison of differences between the graphism samples provided by both groups. Thus, only comparative research makes it possible to determine what is really specific of the patients as compared to the healthy individuals. Only this research plan enables drawing conclusions regarding cause-andeffect relationships between the handwriting traits and psychosis while minimising the potential for errors. The ex post facto approach was used for the empirical analysis of the manuscripts. A supplementary table was developed for each subgroup and each measured variable. The presence or absence of an individual variable was recorded in the table using the binary system. Next, the results obtained for each variable group were entered in the corresponding four-fold table. The strength of association between the handwriting variables and the dependent variables (these graphic aspects which give the manuscript the form typical of schizophrenic sufferer) was measured using the Kendall correlation coefficient Q. This association was further tested for significance using Pearson's chi2 test. The following were considered critical values: Q coefficient of 0.5 and alpha value over 0.05 (df = 1). These critical values did not limit the number of preliminarily confirmed hypotheses concerning the association between the analysed variables and the diagnosis of schizophrenia in an individual to provide the manuscript for the analysis. On the other hand, it also limited the potential for errors and wrong choices. After the handwriting traits which are associated with the writer's psychosis significantly enough to be considered suggestive of schizophrenia were identified and catalogued, the issue of accuracy and reliability of the catalogue in everyday use was addressed. For this purpose, the test typically employed for the assessment of sensitivity and reliability of a given diagnostic method was used. Hence, it was assumed that the catalogue of schizophrenia-specific handwriting traits is a diagnostic test, allowing for diagnosing schizophrenia in an individual to provide a handwriting sample. The following were calculated: sensitivity and specificity of the diagnostic test, the positive and negative predictive value, prevalence rate, positive and negative likelihood ratio and accuracy. Additionally, the neurological and psychiatric aspects of non-subject-specific handwriting samples provided by schizophrenia sufferers were assessed. This approach enabled evaluation of these aspects of handwriting which may reflect neurological abnormalities (i.e. tremor causing letters and words to be deformed) and mental abnormalities, especially personality psychopathology, signs of schizophasia referred to as linguistic pathology typical of schizophrenia, including but not limited to the lack of logic, derailment, echolalia and all other language phenomena linked to language disintegration. RESULTS: Handwriting traits of schizophrenia sufferers 1. Out of 178 variables listed in the catalogue developed during the research, 7 are linked to the writer's psychosis significantly enough to consider them typical of schizophrenic patients. They are itemized below, in the order of the correlation coefficient (Q) magnitude. 2. The seven aforementioned traits should be considered characteristic of handwriting who provided the handwriting samples in this study group. The control experiment also gave some findings, that is three traits, considered to be linked significantly to schizophrenia, which have not occurred in our control handwriting samples provided by the healthy individuals. Hence, the main traits to differentiate the manuscripts of subjects with schizophrenia from the ones of the healthy individuals were the angular ending connective form of the letter "n" as well as the space after the letters "ą" and "ę". The other graphism traits found in the samples provided by the schizophrenic subjects also occurred in the handwriting of the healthy individuals. Nevertheless, the frequency of occurrence was significantly lower or they were plainly rare. The accuracy and reliability of the schizophrenic handwriting trait catalogue application 1. 90% of subjects diagnosed with schizophrenia, whose manuscripts were assessed for the presence of trait from the predefined graphism catalogue, were diagnosed correctly. This means that their manuscripts were classified correctly as the handwriting of a schizophrenic sufferer. 2. 44.6% of healthy individuals with no formal mental health problem were diagnosed correctly. This means that their manuscripts were classified correctly as the No. Variable Q value chi-squared value Significance level (p) 1. The angular ending connective form of the letter "n" 1 12 0,001 2. Space after the letter "ą" 1 5,45 0,025 3. Space after the letter "ę" 1 4,29 0,05 4. The angular beginning connective form of the letter "n" 0,83 6,41 0,025 5. Wavy baseline 0,65 8,15 0,005 6. Slender handwritten letter form 0,6 5,93 0,025 7. The angular beginning connective form of the letter "m" 0,56 4,8 0,05 handwriting of a healthy person, based on the absence of traits from the predefined graphism catalogue. 3. The positive predictive value is 62.79%. Hence, discovering a single trait from the predefined catalogue in a handwriting sample gives 62.79% of probability that an individual actually suffers from schizophrenia. 4. The negative predictive value is 82.35%. Hence, the absence of traits from the predefined catalogue in a handwriting sample gives 82.35% of probability that an individual does not actually suffer from schizophrenia. 5. The possibility that the individual classified as schizophrenic sufferer based on the handwriting analysis (i.e. the sample contained at least one trait typical of schizophrenia) actually suffers from the disease is 1.68-fold higher than the possibility that the healthy individual, with no mental health pathology, will have the positive result of the handwriting assessment. 6. Therefore, the possibility that the individual classified as healthy based on the handwriting analysis (i.e. the sample did not contain any trait typical of schizophrenia) actually suffers from the disease equals just 21.42% of the possibility that the healthy individual, with no mental health pathology, will have the negative result of the handwriting assessment. 7. The likelihood of the correct diagnosis (schizophrenia sufferer vs. healthy individual) made using the described handwriting analysis for the graphism traits typical of schizophrenia listed in the said catalogue is approximately 68.33%. Neurological and psychiatric abnormalities reflected in handwriting 1. Neurological abnormalities are caused not only by the organic (structural) damage to the nervous system but also as a result of functional impairment of the complex, highest level neural structures responsible for speech and language. The former were reflected in the study material as the letter and word deformity, the absence of evenness or homogeneous slant and the presence of amplification, thus symptomatising tremor and ataxia. The latter, though, were mostly symptomatised by agraphia (omitting letters or words in the text or inserting wrong letters or words into it), perseveration (on the level of characters, syllables and words) and paraphrasia. 2. The research partly confirmed the observations made by other scholars studying the handwriting of schizophrenia sufferers. The quality of handwriting of these patients deteriorates with the main changes including: a severe decrease in handwriting legibility, its aesthetic aspects and the linear alignment, b spelling individual words the way they are pronounced, c uneven handwriting, including numerous corrections, d omitting the graphic elements of letters, including diacritical marks in particular, e punctuation errors (mostly including the absence of punctuation marks), f numerous spelling mistakes. 3. The analysis of non-subject specific handwriting samples provided by the subjects was intended to indicate the psychiatric disorders manifesting as the handwriting abnormalities. However, the conclusions seem to be relatively pessimistic from this point of view. Except for manuscript # 10, whose content appears to be the incongruent and nonsense scribbled piece in a form of a word salad, full of bizarre associations and pseudo-religious pathos, all other handwriting samples (except for manuscripts #22 and #27) do not demonstrate significant mental process abnormalities. The manuscripts #22 and #27 include the weird and an incomprehensible juxtaposition of fact as well as the atypical logics and conclusions. The other manuscripts were neither unnatural nor presented with stilted speech, weird pathos, symbolism and associations or unusual style and exaltation. The pressure to write (graforrhea) was not observed, neither was weird juxtaposition of facts and conclusions, addressing pseudo-philosophical topics, perseverations or racing thoughts. 12 subjects categorically refused to provide a non-subject-specific handwriting sample. In a single case, the patient with obvious imperative auditory hallucinations and the delusional reality interpretation, which he had verbalised for some time, refused to provide a 'non-subject-specific' handwriting sample, explaining that the 'voices' had forbidden him to do so. However, others despite their illness provided manuscripts which appeared normal in the assessment and did not reveal any psychopathology. CONCLUSIONS: 1. The attempt to differentiate the graphism of schizophrenia sufferers and healthy individuals ended with a partial success; it also confirmed to some extent the previous findings published by other researchers. The empirical and statistical analyses led to identification of seven handwriting traits, which are closely and significantly related to schizophrenic psychosis. The claim that the said variables must be present in each and every handwriting sample provided by each and every schizophrenia sufferer is obviously wrong. The set of variables is not too extensive to make a good test for presence/ absence of schizophrenia in an individual. However, it is beyond all doubt that the direction of the research is the right one, without the need to generalise that "the graphic signs of schizophrenia" occur in the handwriting of every schizophrenia sufferer. 2. Three handwriting traits from the developed catalogue (a straight ending connective of the letter "n"; the angular beginning connectives of the letters "n" and "m") make the schizophrenic handwriting take a form of the so-called angular, rigid handwriting. which is the trait typical of schizophrenia, according to many authors. When looking at the degree of connection, the spaces were found after the letters "ę" and "ą". Undoubtedly, the degree of connection is an instrument to record the handwriting proficiency. It is also a sensitive factor reflecting the effect of diseases, age, psychophysical fitness etc. on the handwriting of an individual. Hence, the schizophrenic psychosis is reflected by taking the pen/ pencil out of the sheet when writing letters including diacritical marks. How to explain the aforementioned phenomena? The author postulates that one of the factors impacting the the angular connections of letters "m" and "n" is the long-term effect of anti-psychotic medications. As a result of neuroleptic intake, the extra-pyramidal symptoms (EPS) develop, which manifest as muscle rigidity and stiffness. As a result the patient fails to perform the fluent and accurate fine motor manipulation which is a part of handwriting. Instead, the schizophrenia sufferers tend to simplify the letter formation pattern and use angular connectives instead of garland or arcade ones. This can also explain spaces occurring after the letters "ą" and "ę". Due to fine motor disorder, the patient cannot write the diacritical mark in a continuous flow motion, without taking the pen (pencil) out of the sheet. Besides, as the absence of diacritical marks is also typical of schizophrenia, it is likely that the subjects had initially written the letters "ą" and "ę" without the cedillas and having spotted the mistake they corrected their handwriting. Therefore, it is also likely that the mental disease impairs proper associations between the graphic symbols and their phonetic counterparts and as a result the above symptoms emerge in the handwriting. 3. The majority of presented results is not compliant with the published findings of other researchers. The hypotheses suggesting the inclinations of individuals with schizophrenia to produce handwriting of variable slant, elongated ascendents or descendents, falling lines, ascending or descending baseline, wavy lines or increased spaces between words and rows were not confirmed. How can this be explained? The authors of these reports when did not have a control group consisting of healthy individuals when analysing the handwriting of schizophrenia sufferers. The graphism of subjects with schizophrenic psychosis was their only point of focus. As a matter of fact, it is only the comparative research protocol, including the control group consisting of healthy individuals without the obvious signs and symptoms of psychopathology, to enable the actual comparison of differences between the graphism samples provided by both groups. Thus, only comparative research makes it possible to determine what is really specific of the patients as compared to the healthy individuals. Assuming such research plan allows for statistical analysis and drawing conclusions concerning the cause-and-effect relationship between the handwriting traits and psychosis. It also minimises the risk of explaining the observed associations by means of alternative theories and hypotheses. 4. The assessment of the provided manuscripts against the neurological criteria showed the abnormalities also observed by W. Chłopicki and J. S. Olbrycht. Tremor, ataxia, word and letter deformity, lack of evenness (size of individual letters, slant uniformity), agraphia (omitting letter or words in the text, or inserting wrong letters or words into it), perseverations and paraphrasia were found in the analysed handwriting samples. 5. The analysis of patient's non-subject-specific handwriting pieces against the psychiatric criteria showed mental state alterations in 3 cases only. Others, despite their illness, provided manuscripts which appeared normal in the assessment and did not reveal any psychopathology. How can this be explained? This may, for instance, be attributed to the relatively good adaptation skills of these patients, which are able to adjust their production to social norms. On the other hand, they might intentionally try to mislead others, especially the person collecting their written verbal production samples. However, the author argues that the key factor contributing to such outcomes was medical treatment used in all patients. Medical treatment of schizophrenia mainly affects its positive symptoms such as delusions, hallucinations, disorganized speech and behaviour. It affects the negative symptoms of schizophrenia, such as anhedonia or autism, to much lesser extent. All subjects had been on the anti-psychotic treatment for at least 5 years. Therefore, it can be assumed that the treatment they received proved to be effective in preventing symptoms of schizophrenia, especially resolving axial symptoms and disorganisation. Additionally, it promoted relatively good subjective and objective social function of the affected individuals. Even if the above statement is too farreaching, it should be noted that even the use of inadequately effective medications in chronically ill patients (and so were our subjects), limits the destructive effect of disease symptoms and improves the objective and subjective measures of real-life functioning To sum up, apart from the three described manuscripts, the study did not confirm language pathology or symptoms of thought disorder as key characteristics of written verbal production of schizophrenic patients. Perhaps different conclusions could be drawn from the speech analysis of patients with schizophrenia who are not treated. However, further research is necessary to investigate into the matter in a more conclusive manner. 6. From the methodology perspective, the research contributed to the insight into the language pathology in schizophrenia and in particular into the handwriting abnormalities found in the sufferers' manuscripts. The ultimate solution to the problem of graphism and linguistic pathology in schizophrenia is still ambiguous, if it can be solved at all. And so it is going to remain, unless the psychiatrists and neuroscientists determine conclusively what the actual mechanism of schizophrenia development is.

Nonostante la comprovata presenza di alterazioni a carico del linguaggio nei disturbi dello spettro schizofrenico (DSS - American Psychiatric Association, 2013), la piena caratterizzazione del fenomeno non è ancora stata raggiunta. L’ipotesi della “schizofrenia come prezzo da pagare per il linguaggio" (Crow, 1997) apre nuove prospettive al problema sotto osservazione e suggerisce la necessità di un approccio volto a integrare gli strumenti attualmente utilizzati per la valutazione clinica delle abilità linguistiche nei DSS. L’obiettivo generale del presente lavoro è l'avanzamento nella comprensione dei disturbi del linguaggio in questa popolazione. A tal fine è stato adottato un approccio interdisciplinare a cavallo tra la neuropsicologia, la psicolinguistica e la linguistica computazione. In particolare, il presente lavoro si concentra: i) sullo studio dell’interazione tra il magazzino semantico e le funzioni esecutive ai compiti di fluenza verbale; ii) sulla produzione e la comprensione della struttura argomentale del verbo e della complessità sintattica; e iii) sulla sensibilità alle violazioni semantiche a carico di diversi ruoli tematici. Quarantatré persone con DSS sono state reclutate presso l’IRCCS Fatebenefratelli di Brescia. I processi di elaborazione linguistica dei partecipanti sono stati studiati attraverso: i) due fluenze verbali analizzate adottando sia punteggi tradizioni, sia algoritmi di Natural Language Processing (NLP); ii) la Northwestern Assessment of Verb Argument Structure (NAVS – Cho-Reyes & Thompson, 2012; Barbieri et al., 2019); iii) uno studio sui movimenti oculari durante un compito di lettura di frasi con violazioni semantiche. Come confronto, lo stesso protocollo sperimentale è stato somministrato a un campione di soggetti sani di controllo appaiati per sesso ed età. Nei compiti di fluenza verbale si sono osservate differenze significative tra i due gruppi relativamente alla dimensione media dei cluster semantici, al numero di switch tra cluster, nonché alle misure di coerenza semantica, mettendo in evidenza il contributo differenziale e non mutualmente esclusivo dell’integrità del magazzino semantico e delle funzioni esecutive alla fluenza verbale. Inoltre, gli algoritmi sperimentali NLP basati sulle misure adottate hanno dimostrato un’elevata prestazione nella classificazione dei soggetti con o senza DSS. Dai risultati della batteria NAVS è stato inoltre possibile identificare una difficoltà specifica dei pazienti rispetto a strutture argomentali complesse, nonché rispetto a frasi aventi un ordine delle parole non canonico, sia in produzione sia in comprensione, compatibili con la Argument Structure Complexiy Hypothesis (ASCH – Thompson, 2003) e con un deficit del movimento sintattico che soggiace alle frasi non canoniche (Chomsky, 1981). Infine, tramite lo studio dei movimenti oculari è stato possibile osservare una diminuita sensibilità alle violazioni sul ruolo tematico di “Agente”, compatibile con la presenza di un “disturbo del Sé” (Henriksen & Noordgard, 2014) nei DSS. In conclusione, i nostri risultati confermano la presenza di deficit specifici a carico delle abilità semantiche e sintattiche osservabili in produzione e in comprensione nei DSS. Inoltre, l’esito dello studio supporta l’applicazione di un approccio multi-disciplinare al problema in oggetto. Il presente studio dimostra come misure di fluenza verbale derivate da un approccio linguistico-computazionale associate a una dettagliata caratterizzazione del linguaggio recettivo e produttivo nei DSS grazie agli strumenti e alle cornici teoriche della psicolinguistica possono contribuire all'avanzamento nella caratterizzazione delle modificazioni del linguaggio nei DSS oltre allo stato dell’arte.
Although the presence of language disturbances in people with Schizophrenia Spectrum Disorders (SSD) is well established (American Psychiatric Association, 2013), a full characterization of the phenomenon is still missing. The hypothesis of “schizophrenia as the price we pay for language” (Crow, 1997) opens new perspectives on the problem at stake, and suggests the need for a combined approach aiming at integrating the clinical tools nowadays employed to assess language abilities in SSD. The overall objective of the present work is to advance the understanding of language disturbances in this population by adopting an interdisciplinary approach embracing neuropsychology, psycholinguistics, and computational linguistics. In particular, the present work is focused on: i) the differential contribution of semantic storage and executive functions to verbal fluency; ii) the production and comprehension of verbs argument structure and syntactic complexity, and; iii) the sensitivity to semantics violation on different Thematic Roles. Forty-three persons with SSD were recruited at the IRCCS Fatebenefratelli of Brescia. Participants’ linguistic processes were investigated by means of: i) two verbal fluency tasks for the evaluation of semantic store integrity and executive function performance, both computed manually and derived from Natural Language Processing (NLP) methodologies; ii) the Northwestern Assessment of Verb Argument Structure (NAVS – Cho-Reyes & Thompson, 2012; Barbieri, Brambilla, Thompson, & Luzzatti, 2019); iii) an eye-tracking study on semantic violations. For comparison, the same battery was administered to a sample of healthy control subjects matched by age and gender. In the fluency tasks significant differences in the mean size of semantic clusters, number of switches, as well as measure of coherence were observed between groups, highlighting the differential and non-mutually exclusive contribution of the semantic store integrity and the executive functions to verbal fluency. Moreover, NLP-derived algorithms shown a high-level performance in classifying subjects with and without SSD. A specific difficulty with complex verb argument structure, as well as with non-canonical word order of sentences, both in production and comprehension, was identified in the SSD population. These results are compatible with the Argument Structure Complexity Hypothesis (ASCH – Thompson, 2003) and the presence of an underlying syntactic movement in non-canonical sentences (Chomsky, 1981). Finally, an impaired sensitivity to semantic violations on the “Agent” was observed in the eye-tracking study, compatible with the presence of a “disorder of the self” (Henriksen & Noordgard, 2014) in this population. In summary, our results underline the presence of specific semantic and syntactic impairments in SSD as seen in language production and comprehension. Moreover, our result support the application of a multi-disciplinary approach to the issue at stake. Our study show how the added value of fluency measures derived by a computational linguistic approach paired with a fine-grained characterization of receptive and productive language in SSD by means of the tools and theoretical frameworks derived from psycholinguistics can contribute to further characterize language modifications in SSD beyond the current knowledge.

Bakgrund: Schizofreni är en allvarlig psykisk sjukdom kännetecknad av svikt i kognitiva och sociala förmågor. Det råder otillräckliga kunskaper i bemötandet av personer med schizofreni. Deras subjektiva upplevelser blir oftast åsidosatta fastän de spelar en viktig roll i vården och personers liv. En bättre förståelse för personers subjektiva dimensionen kan bidra till ett bättre bemötande och minska lidande för personer med schizofreni. Syfte: Syftet för denna studie är att undersöka subjektiva upplevelser hos personer med schizofreni. Metod: Nio kvalitativa artiklar som hittades i databaserna PsycINFO och CINAHL bearbetades med metasyntes, gemensamma teman kunde identifieras. Resultat: Personer med schizofreni upplever en komplex blandning av upplevelser såsom tillbakadragande, ensamhet, relationsproblem, hopplöshet, kaos och förvirring som effekter av sjukdomen. Trygghet och gemenskap kan bidra till en positiv utveckling av hälsoprocesserna. Diskussion: Livsvärlden ligger till grund för hur personer med schizofreni upplever sin sjukdom och livssituation. Upplevelser av negativa symtom hos personer med schizofreni kräver mer forskning. Bemötandet av personer med schizofreni kan genom fortsatt forskning och utbildning förbättras.

Schizofreni är en psykisk sjukdom där personens upplevelse av sjukdomen är en viktig utgångspunkt för sjuksköterskans omvårdnad. För att förbättra vården krävs mer kunskap om hur det är att leva med schizofreni. Syftet med studien var därför att beskriva upplevelsen av att leva med den psykiska sjukdomen schizofreni. Studien genomfördes som en allmän litteraturstudie. Litteratursökningen gjordes systematiskt, vilket gav 14 vetenskapliga artiklar som utformade resultatet. En innehållsanalys genomfördes, vilket resulterade i tre kategorier: utanförskap, förluster och värdefullt liv. Resultatet visade att personer med schizofreni kände ensamhet och utanförskap. Sjukdomen bidrog även till stora förluster i livet. Trots motgångar framkom flera faktorer som kunde leda till ett värdefullt liv. Personer med schizofreni upplevde att hälso- och sjukvårdspersonal behövde visa hänsyn, lyssna samt ge utrymme för att kunna skapa ett gott vårdande. En ökad kunskap om sjukdomen rekommenderas för att minska stigmatiseringen av schizofreni. Fortsatt forskning om hur hälso- och sjukvårdspersonal bör bemöta personer med schizofreni efterfrågas.
Schizophrenia is a mental illness where the person’s experience of the disease is an important basis for nursing care. To improve the care, more knowledge is required about the experience of living with schizophrenia. The aim of the study was to describe the experience of living with the mental illness schizophrenia. The study was conducted as a literature study. The literature search was done systematically, resulting in 14 scientific articles that shaped the outcome of the study. A content analysis was conducted, which resulted in three categories: alienation, losses and valuable life. The results showed that people with schizophrenia feel loneliness and alienation. The disease also contributed to huge losses of life. Despite setbacks several factors that could lead to a meaningful life was revealed. To create good caring, people with schizophrenia felt that health professionals need to show respect, listen and give space. Increased knowledge about the disease is recommended to reduce the stigma of schizophrenia. Further research on how health professionals should behave against people with schizophrenia is requested.

Schizofreni beskrivs som ett svårt psykiatriskt tillstånd och en komplex gåta. Det är inte en vanlig sjukdom men den utgör en av de mest betungande och kostsammaste i världen. Sjukdomen medför en ofrivillig isolering, ett outhärdlig lidande samt osäkerhet till livet i stort. Sjuksköterskor har en central roll i mötet med dessa patienter och för dess tillfrisknande. För detta krävs det att man förstår samt tar del av patientens unika livsvärld. Syftet med denna litteraturstudie var att beskriva upplevelsen av att leva med schizofreni. Den systematiska litteratursökningen resulteradei 15 stycken vetenskapliga artiklar med kvalitativ ansats. Dessa analyserades genomen kvalitativ innehållsanalys med fokus på det manifesta. Fem stycken slutkategorier kunde slutligen presenteras: att uppleva en förändrad verklighet, att uppleva maktlöshet och sociala utmaningar, att uppleva trygghet i sjukvården, att känna sig älskad och finna gemenskap samt att uppleva hopp och finna copingstrategier. Resultat visade att personer med schizofreni upplevde ensamhet till följd av förlorad självkontroll samt stigmatisering. Den förlorade kontrollen över tillvaron resulterade även i en känsla av maktlöshet. Slutsatser av denna litteraturstudie var att ökad kunskap gällande sjukdomen har en positiv inverkan på individenslivskvalité. Kunskap avser så väl personens egen kunskap samt omgivningens förståelse för hur denna sjukdom ter sig.

Att drabbas av schizofreni påverkar hela personens livssituation. Schizofrenin medför funktionsnedsättningar som gör det svårt att ta tillvara på de vardagliga resurserna. Syftet med denna litteraturstudie var att beskriva hur personer med schizofreni upplever sin livssituation. Metoden som användes var en litteraturstudie. Sökningarna gjordes i Cinahl, Psycinfo och Elin@Kalmar. Åtta vetenskapliga artiklar har kvalitetsgranskats och analyserats vilket resulterades i fyra kategorier av upplevelser: upplevelser av ohälsa, upplevelser av relationer, upplevelser av sysselsättning och oro inför framtiden. Dessa upplevelser påverkade livssituationen i flera olika avseenden. Denna litteraturstudie är av betydelse för vårdpersonal eller anhöriga till en person med schizofreni för att förstå dennes livssituation och på så sätt bemöta dem på ett tillfredställande sätt.

 

 

Schizofreni är en psykotisk störning som drabbar knappt en procent av den vuxna befolkningen. En börda för hela familjen uppstår när en familjemedlem insjuknar i schizofreni. Syftet var att belysa närståendes upplevelser och hantering av att leva med en schizofren person, samt vilket eventuellt stöd de var i behov av. Metoden var en systematisk litteraturstudie som utfördes genom systematisk sökning, kritisk granskning och sammanställning. Resultatet identifierade fyra kategorier och sju subkategorier: Upplevelser med subkategorin känslor, familjebelastning med subkategorin börda, coping med subkategorierna negativ coping och positiv coping, samt stödbehov med subkategorierna utbildning, socialt stöd och professionellt stöd. Resultatet visade att dessa kategorier integrerade med varandra och påverkade de närståendes situation. Diskussionen visade att kategorierna påverkade varandra i flera dimensioner. Viktigaste faktorn som påverkade närståendes livssituation var copingstrategier. Slutsatsen visade att samtliga närståendes komplicerade situation kräver en holistisk syn och vård från vårdprofessionen, som bör vidareutvecklas.

Bedre forståelse og behandling av negative symptomer ved schizofreni er viktig ettersom negative symptomer assosieres med dårlig funksjonsevne og prognose. Negative symptomer har vist seg å respondere dårlig på medikamentell behandling, noe som gjør at psykososiale behandlingsmetoder i større grad bør implementeres. Denne oppgaven presenterer en rekke ulike biologiske og psykososiale forståelsesmodeller omkring negative symptomer, etterfulgt av en mer nøyaktig beskrivelse av ulike behandlingsintervensjoner. Kognitiv atferdsterapi har vist seg å være en lovende terapiform i dette øyemed, og baserer seg på en kognitiv kasusformulering av de negative symptomene. Kognitive modeller antar at negative symptomer oppstår og vedlikeholdes av dysfunksjonelle holdninger og antakelser, som igjen ofte er en reaksjon på nevrokognitive svekkelser og uheldige livshendelser. Oppgaven gjennomgår empirien på området, og peker samtidig på behovet for både biologiske og psykososiale forståelsesmodeller og intervensjoner i forhold til negative symptomer ved schizofreni.

Hälsa anses vara en mänsklig rättighet och är svårdefinierbart då det upplevs olika av olika individer. Psykisk ohälsa behöver inte innebära en psykiatrisk diagnos . Den definieras snarare utifrån hur man hanterar olika livssituationer som kan stötas på under livets gång. Schizofreni är en livslång och allvarlig sjukdom som påverkar hur personen tänker, känner och beter sig. De svåra symtomen som sjukdomen innebär kan vara begränsande för den drabbade, vilket kan få konsekvenser för den fysiska hälsan. Syftet med studien var att beskriva hur litteraturen skildrar den fysiska hälsan hos vuxna personer med schizofreni. Metoden som användes var en allmän litteraturstudie där 11 kvantitativa studier analyserades. I resultatet framkom två kategorier med ett antal underkategorier: Riskfaktorer för sjukdom hos vuxna personer med schizofreni och Vanliga somatiska sjukdomar hos vuxna personer med schizofreni. En rad olika bidragande faktorer för ohälsa förekommer hos personer med schizofreni, vilket leder till att de drabbas av fysisk ohälsa. Slutsatsen är att personer med schizofreni löper större risk att drabbas av fysisk ohälsa på grund av olika livsstilsfaktorer.
Health is considered a human right and is difficult to define as it is experienced differently by different individuals. Mental illness does not necessarily mean a psychiatric diagnosis. It is defined rather from how to handle different situations that people may encounter throughout life. Schizophrenia is a lifelong and serious disease that affects how the person thinks, feels and behaves. The severe symptoms of the disease may be limiting for the affected person, which may have implications for physical health. The purpose of this study was to describe how the literature portrays the physical health of adults with schizophrenia. The method used was a literature review where 11 quantitative studies were analyzed. The results revealed two categories with several subcategories: Risk factors for disease in adults with schizophrenia and Common illnesses in adults with schizophrenia. A variety of contributing factors for the illness occurs in people with schizophrenia, with the result that they suffer from physical illness. The conclusion is that people with schizophrenia are at greater risk of physical ill health because of various lifestyle factors.

Bakgrund: Schizofreni är en psykossjukdom med hög suicidrisk. Det vanligaste symtomenet vid schizofreni är hörselhallucinationer som kan upplevas både i positiv och negativ anda. Det råder stigmatisering kring sjukdomen där kunskapsbrist och rädsla för personen tros ligga till grund. Syfte: Att beskriva vuxna personers upplevelser av hörselhallucinationer vid schizofreni. Metod: Litteraturöversikten baserades på 12 vetenskapliga artiklar där nio av dem hade en kvalitativ ansats och tre med kvantitativ ansats. Dessa artiklar hämtades från databaserna CINAHL Complete, PubMed och PsycINFO. I databaserna användes följande sökord: hallucination, voice hearing, psychosis, patient, life, hearing voices, nursing, people who hear voices, auditory hallucinations, schizophrenia och experiences. Resultat: Resultatet delades upp i fyra teman: I Röstens natur och intention beskrevs röstens ton, känsla, intensitet och varaktighet. Relationen till rösten belyste personens identifiering och personifiering av rösten där den kunde ses som något kroppseget eller som en enskild individ. Meningsskapande och copingstrategier angav olika strategier personen använde i syfte att klara av och hantera rösterna. Påverkan på individen belyste hur personen påverkades av rösten genom förändrad självbild och självskada, isolering och kontrollförlust. Diskussion: Resultatet diskuterades utifrån begreppen livsvärld och meningsskapande där meningsskapandet kunde ses som en central del i personens förmåga att hantera situationen med hörselhallucinationerna.
Background: Schizophrenia is a mental disorder with a high suicidal risk. The most common symptoms experienced with schizophrenia are auditory hallucinations which can be experienced both in a positive and a negative way. The disorder is stigmatized most likely due to a lack of knowledge and a fear of the person. Aim: To describe adults experiences of auditory hallucinations induced by schizophrenia. Method: The literature review consisted of twelve scientific articles of which nine were conducted using a qualitative approach and three with a quantitative research methodology. The articles were found in the databases CINAHL Complete, PubMed and PsycINFO. The following words were used in the databases: hallucination, voice hearing, psychosis, patient, life, hearing voices, nursing, people who hear voices, auditory hallucinations, schizophrenia and experiences. Results: The results were divided into four themes: The nature of the voice described the characteristics of the voice i.e. tone, feeling, intensity and duration. The relation to the voice described how the affected persons identified the voice as a part of themselves. Finding meaning and coping strategies described the different strategies which were used to cope with the voices. The impact on the individual highlighted how the person was affected by the voices by an altered self, added self-harm behavior, isolation and loss of control. Discussions: The results were discussed with the concepts of life world and finding meaning. Finding meaning was found as one of the affected person’s most important coping strategies for dealing with the auditory hallucinations.

BAKGRUND: Schizofreni är en allvarlig psykiatrisk sjukdom som innebär ett stort lidande för den drabbade. Sjukdomen kan leda till symtom så som hallucinationer, förvrängd verklighetsuppfattning, apati och tillbakadragenhet. Sammantaget innebär detta att patienter med schizofreni skattar sin Quality of Life lägre än genomsnittspopulationen. SYFTE: Syftet med litteraturöversikten var att belysa vilka faktorer som påverkar Quality of Life hos personer med diagnosen schizofreni och som behandlas i öppenvården. METOD: Undersökningen genomfördes som en litteraturöversikt. Tio vetenskapliga artiklar som stämde överens med studiens syfte ingick, de granskades kvalitémässigt och genomgick en strukturerad analys. RESULTAT: De identifierade faktorer som påverkade Quality of Life hos personer med schizofreni delades in i tre huvudkategorier som var synonyma med Anontonvskys KASAMbegrepp: begriplighet, hanterbarhet och meningsfullhet. Som underkategorier till dessa begrepp identifierades följande underkategorier: Positiva symtom, den kognitiva förmågan, den psykosociala situationen, att ha kontroll över vardagen, fysisk hälsa, stöd från vården och livsglädje och optimism. Sammanfattningsvis visar artiklarna att de tre huvudkategorierna identifierar områden där patienterna har en låg funktionsgrad. De sju underkategorierna identifierar i sin tur områden som direkt eller indirekt påverkar patientens Quality of Life. SLUTSATS: Sjuksköterskan kan på egen hand eller tillsammans med andra yrkeskategorier inom vården stärka Quality of Life hos personer med schizofreni, dels genom motiverande samtal men också genom samordnade insatser mellan olika samhällsaktörer. KLINISK BETYDELSE: Personer med schizofreni upplever socialt utanförskap, brist på sysselsättning och isolering som faktorer som påverkar deras livssituation negativt. Som vårdgivare är det av största vikt att möta patienten i dess upplevda problem för att få ett positivt behandlingsresultat.
BACKGROUND: Schizophrenia is a serious psychiatric illness, which entails great suffering for the person afflicted. The illness may cause symptoms such as hallucinations, a distorted sense of reality, apathy and reclusiveness; in effect causing the schizophrenic patient to evaluate his or her Quality of Life as being lower than the average persons. PURPOSE: The purpose of the literature review, was to highlight which factors affect Quality of Life, for schizophrenic patients in outpatient care. METHOD: The study was carried out as a literature review. Ten scientific articles, well suited for the purpose of this paper, were critically reviewed and structurally analyzed. RESULT: The identified factors, influencing Quality of Life for patients suffering from schizophrenia, were divided into three main categories, synonymous with Antonovsky's concept of KASAM: comprehensibility, manageability and meaningfulness. Furthermore, seven concepts were identified as constituting subcategories: positive symptoms, the psychosocial situation, maintaining control of ones everyday life, physical health and support from health facilities and exuberance and optimism. In summary, the articles studied show that the three main categories identify areas, in which the patients are low functioning. The seven sub-categories in their turn identify areas that directly or indirectly affect the patients' Quality of Life. CONCLUSION: The nurse can improve Quality of Life in individuals diagnosed with schizophrenia, either on her own, or in collaboration with other professionals in the health care sector. This can be achieved through motivational talks, but also through coordinated efforts between various social actors. CLINICAL SIGNIFICANCE: Patients suffering from schizophrenia, perceive exclusion in the social arena, a lack of pursuit and/or employment and general isolation as factors negatively affecting their lives. Thus the ability of caregivers, to meet the perceived problems and needs of the patient, is paramount when striving for a positive outcome of treatment.

Syftet med denna deskriptiva litteraturstudie var att beskriva sjuksköterskors attityder till personer med schizofreni. Litteratursökningen genomfördes i databasen Medline (via PubMed) där totalt 15 vetenskapliga artiklar valdes ut och granskades. Resultatet visade att sjuksköterskor ansåg att schizofreni inte kan härledas till en enda orsak utan är ett samspel mellan olika faktorer. Schizofreni betraktades som en behandlingsbar sjukdom och endast delvis återhämtning ansågs möjlig förutsatt att professionell hjälp finns att tillgå. Sjuksköterskor hade negativa attityder angående sjukdomens prognos. Negativa attityder påträffades också gällande personer med schizofreni i relation till giftermål och barn. Det rådde delade meningar om det skulle vara besvärande eller inte att ha en person med schizofreni som granne eller arbetskamrat. Sjuksköterskor ansåg att personer med schizofreni är aggressiva och oförutsägbara. Positiva attityder fanns till att personer med schizofreni ska ha samma rättigheter och bemötas som andra människor. Yrkeserfarenhet påverkade attityderna hos sjuksköterskorna men det var oklart om det bidrog till positiva eller negativa attityder. Att ha högre utbildning var relaterat till positiva attityder. Författarna drog slutsatsen att sjuksköterskor i allmänhet har negativa attityder till personer med schizofreni.

Nyckelord: Schizofreni, attityd, sjuksköterskor.

Patienter som har diagnosen schizofreni är inte unikt samlade inom den psykiatriska vården utan finns inom alla vårdspecialiteter. En viktig del av omvårdnadsarbetet hos de sjuksköterskor vilka möter dessa patienter är etablerandet av en vårdande relation med dem. Det är i denna relation som omvårdnaden tillämpas. Syftet med studien var att sammanställa och belysa forskning som beskriver sjuksköterskans vårdrelation med en patient som har diagnosen schizofreni. I en systematisk litteraturstudie granskades och analyserades åtta vetenskapliga artiklar vilket resulterade i tre huvudteman relaterade till vårdrelationen: ´etablera en vårdande relation´, ´främjar utvecklingen av vårdrelationen´ samt ´hämmar utvecklingen av vårdrelationen´. Innehållet i dessa teman framhäver att vårdrelationen är ett komplex fenomen bestående av många aspekter. Genom en förståelse utav dessa aspekters proportioner samt påverkan kan de utav sjuksköterskor ägnas medvetna åtgärder i syfte att stärka relationen till patienten och öka kvaliteten på omvårdnaden.

Background          Schizophrenia has been negatively observed in today’s society due to several major violent crimes and violent actions committed by persons with the diagnosis. The general populations’ lack of knowledge increases the risk of a faulty attitude when meeting individuals with schizophrenia. Schizophrenia is a psychosis which creates suffering for the effected. Common symptoms of schizophrenia are hallucinations, delusions, apathy and difficulties with emotional relations. Nearly half of all schizophrenics attempts suicide, at some point.   Aim                        The aim of this study was to describe how people with schizophrenia experience their life-world.               Method                  This study is based on six autobiographies and is analyzed with qualitative content analyses.   Results                   The study resulted in six categories which are perception of their illness, positive symptoms, negative symptoms, suffering, experiences of health care and medication and strategies towards a brighter future. During psychotic periods the individuals often experienced their surrounding as frightening because of hallucinations. Some of them live their lives alone because they are afraid of being perceived as crazy and want to conceal their diagnosis. The result shows strategies that the persons were using for reducing their suffering.                                  Conclusion            Prejudices about the disease can generate that persons with schizophrenia is not getting the care they need. If the patient is treated based on a life-world perspective, he or she will feel like being seen as a person rather than a diagnosis.

The aim of the study was to illustrate how music therapy can be used in the care of patients with schizophrenia and other psychotic illness. The method used was a literature review. Scientific articles were searched in PubMed, Cinahl, PsycINFO och Scopus databases with an outcome of ten articles, with in total 330 participants, that underwent quality and outcomes analysis. The results showed that music therapy could provide potential improvement in the patients' social functions and that it could also improve negative, some positive and general schizophrenia and psychotic symptoms in some patients. The form of music therapy used was often creative music activities with music therapist, with or without structure, or individually customized. The length of treatment varied widely. It was not possible to draw conclusions about which type of music therapy was best. In the studies where patients' experience came up, music therapy often made ​​them feel good. The conclusion: The study has shown that music therapy can generally mitigate negative symptoms and improve social behavior. More research is needed to more clearly show the relation between music therapy and improvement in symptoms.