Дисертації: "Functional psychose"

1

Gonterman, Andrea R. "The relationships between insight, psychopathological symptoms, and neurocognitive function in psychotic disorders." Thesis, University of North Texas, 2001. https://digital.library.unt.edu/ark:/67531/metadc3054/.

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Many psychotic patients fail to admit they are mentally ill. The current study evaluated the associations between insight, specific symptoms, and neurocognitive impairments. Thirty-three acute inpatients with a schizophrenia, schizoaffective disorder, or psychotic disorder NOS diagnosis were rated on the SAIE, Birchwood's IS, and the BPRS. Neurocognitive assessments of attention and frontal lobe functioning were also conducted. Stepwise multiple regression analyses found composites representing delusions, disorganization, and anxiety/depression, as well as CPT-IP shapes hit rate, served as significant predictors of total insight or the specific insight dimensions. At least for acute patients, symptoms tended to have stronger relationships with and were more regularly predictive of insight than neurocognitive measures, though the attentional task associated with right hemisphere functioning, contributed significantly.

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2

McConville, Pauline Mary. "Obstetric complications and functional psychosis." Thesis, University of Edinburgh, 2007. http://hdl.handle.net/1842/24928.

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The main body of the work is a study of the rates of obstetric complications in 492 patients meeting ICD-9 criteria for schizophrenia, affective disorder and other functional psychosis, compared to their 797 non-psychotic siblings and to 2,460 normal controls. The main results, for each of the three diagnostic groups, indicate significant confounding between obstetric complications, maternal marital status and social class. No single obstetric complication remained associated with schizophrenia once these factors had been controlled for. Bleeding in pregnancy was associated with an increased risk of affective disorder compared to controls. A low Apgar score at 5 minutes was associated with an increased risk of affective disorder compared to controls. Low social class and maternal marital status were also associated with the risk of affective disorder. Induction of labour or elective caesarean section was associated with an increased risk of other functional psychosis compared to their non-psychotic siblings. Secondary analyses of the effect of season of birth, age of onset of illness and family history are presented. Schizophrenic patients were more likely to have been born in winter than their siblings but winter-born schizophrenics had similar rates of OCs to those born at other times. An induced labour or elective caesarean section was associated with an increased risk of affective disorder of early onset and of non-familial affective disorder. Bleeding in pregnancy was also associated with an increased risk of non-familial affective disorder. The findings are compared to those of other studies and conclusions are drawn about the importance of obstetric complications in the aetiology of psychotic disorders, with particular emphasis on schizophrenia, and suggestions are made for further research.

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3

Corlett, Philip Robert. "Causal learning and psychosis : exploring brain function, cognition and symptoms using functional neuroimaging and psychopharmacology." Thesis, University of Cambridge, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.614249.

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4

Cheung, Sze-ki, and 張斯琪. "The relationship of DUP, DUI, negative symptom severity and functional outcome among people with psychosis in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/192962.

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Empirical studies had demonstrated inconsistencies between duration of untreated psychosis (DUP) and outcome measures including negative symptoms severity and functional outcome. Therefore, this study aimed to investigate how either the construct of duration of untreated psychosis (DUP) or duration of untreated illness (DUI) acted on associating and predicting negative symptoms, its sub-domains and functional outcome among psychotic population in Hong Kong. Totally three hundred and forty five subjects were recruited from in-patient and out-patient setting in hospitals under hospital authority. DUP and DUI were assessed by semi-interviewed with subjects, their family members and other significant others. And the Scale of Assessment of Negative Symptoms (SANS) and Social and Occupational Functioning Assessment Scale (SOFAS) were adopted as assessment tools to measure negative symptoms severity and functioning of individual respectively. Regression models were used to analyse how DUI and DUP differed in associating and predicting different variables. Results showed that DUI took a more significant role in associating and predicting negative symptoms and functional outcome in which it demonstrated stronger positive correlation with negative symptoms and stronger negative correlation with functional outcome. DUI was also found to act as a potential predictor for both negative symptom severity and functional outcome. At the same time, among all sub-domains, anhedonia showed mild positive correlation with both DUI and DUP while other four didn’t show similar association. The results provided increased insight that DUI might play a more significant role in determining the development of negative symptoms and functional outcome than DUP. Yet, limitations on various aspects had been addressed in this study such as the high level of heterogeneity of our sample and potential confounders which partially correlated with the outcome parameter. Also, no causal relationship had been yield between DUI / DUP and outcome variables. Further investigation was suggested on dividing the sample into sub-group to draw information regarding the characteristics of associations. Meanwhile, better control on potential confounding variables might help generating clearer picture on how independent variables associated with each other.
published_or_final_version
Psychological Medicine
Master
Master of Psychological Medicine

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5

Os, Johannes Jacobus van. "(Genetic) epidemiology as a tool to identify risk factors for emergence and persistence of illness in the functional psychoses." Maastricht : Maastricht : IPSER Foundation ; University Library, Maastricht University [Host], 1995. http://arno.unimaas.nl/show.cgi?fid=5789.

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6

Dixon, Tracy Anne. "The neuropsychology and functional anatomy of verbal fluency in the major psychoses." Thesis, King's College London (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322578.

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7

Padovan, Giordano B. "Psychoses, language and brain asymmetry: fMRI connectivity alterations in bipolar disorders." Doctoral thesis, Università degli studi di Padova, 2018. http://hdl.handle.net/11577/3423164.

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INTRODUCTION A mood characterised by alternating mania and depression have been matter of curiosity and attention since ancient times. According to T.J. Crow’s theory on psychosis, Schizophrenia is strictly linked to the development of the faculty of language (begun in hominids from 6 to 4.2 million years ago) which depends by (anatomical and functional) asymmetry observable between the two cerebral hemispheres (Crow 2004). Several data in the recent (and older) (Griesinger 1845) scientific literature support the hypothesis that schizophrenia and bipolar disorder are similar due to a large number of partially common features: symptomatology, genetics, cognitive features, neurobiology, connectivity alteration, etc.. A brief historical account about how often the classification of this disease changed across the last two centuries may suggest how the knowledge underling this diagnostic category is still fragile. AIM OF THE RESEARCH The goal of this paper is to study Functional Connectivity (FC) among bipolar patients and to test the compatibility of Crow’s paradigm with Bipolar Disorder, verifying the potential presence of hemispheric asymmetry alteration (left dominance deficit) through fMRI analysis. MATERIALS AND METHODS 18 outpatients of the Mood Disorders Unit at the Psychiatric Clinic of the University of Padua have been recruited. All subjects had a diagnosis of Bipolar Disorder type I or type II, according to the criteria of the DSM-IV-TR). 16 healthy individuals were chosen matched for age, sex and education. Clinical and psychological conditions at the time of the experiment were investigated through some psychometric scales widely used for the evaluation of mood, anxiety and other psychopathologic aspects. All subjects underwent a MRI scan both in resting state and while they were attending two tasks: a phonemic (verbal fluency) exercise and a visuo-spatial test (mental rotations). RESULTS From the neuropsychological point of view the phonemic task revealed no significant (p<0.05) differences between groups; on the contrary patients group showed decreased performance at the visuo-spatial task. MRI FC was analysed using two different techniques. Independent Component Analysis (ICA) showed mainly a volume within the Dorsal Attention Network located in left Precuneus (Brodmann Area 7) where patient group presented a reduction of FC compared to controls. Graph analysis brought to light a number of inter-hemispheric and left intra-hemispheric connections revealed to be significantly less active in patients compared to controls, on the contrary substantial conservation of indices at the Network Level was observed.
INTRODUZIONE Un tono timico caratterizzato da un’alternanza di mania e depressione è stato oggetto di interesse e attenzione fin dai tempi antichi. Secondo La teoria di T.J. Crow sulla psicosi, la schizofrenia è strettamente legata allo sviluppo della facoltà del linguaggio (che ha avuto origine negli ominidi da 6 a 4,2 milioni di anni fa) che dipende dall'asimmetria (anatomica e funzionale) osservabile tra i due emisferi cerebrali (Crow 2004). Diversi dati nella letteratura scientifica recente (e più antica – Griesinger 1845) supportano l'ipotesi che la schizofrenia e il disturbo bipolare siano simili per un gran numero di caratteristiche parzialmente comuni: sintomatologia, genetica, cognitività, neurobiologia, alterazione della connettività, ecc. Un breve resoconto storico di quanto spesso la classificazione di questa malattia sia cambiata negli ultimi due secoli può suggerire come la conoscenza sottesa a questa categoria diagnostica sia ancora fragile. SCOPO DELLA RICERCA L'obiettivo di questo studio è quello di studiare la connettività funzionale (FC) tra i pazienti bipolari e testare la compatibilità del paradigma di Crow con il disturbo bipolare, verificando la potenziale presenza di alterazioni dell'asimmetria emisferica (deficit di dominanza sinistra) attraverso l'analisi fMRI (risonanza magnetica funzionale). MATERIALI E METODI Sono stati reclutati 18 pazienti ambulatoriali dell'Unità di Disturbi dell'Umore presso la Clinica Psichiatrica dell'Università di Padova. Tutti i soggetti avevano una diagnosi di disturbo bipolare di tipo I o di tipo II, secondo i criteri del DSM-IV-TR). Sono stati scelti 16 individui sani abbinati per età, sesso e istruzione. Le condizioni cliniche e psicologiche al momento dell'esperimento sono state studiate attraverso alcune scale psicometriche ampiamente utilizzate per la valutazione dell'umore, dell'ansia e di altri aspetti psicopatologici. Tutti i soggetti sono stati sottoposti a una risonanza magnetica sia in stato di riposo che durante l’esecuzione di due compiti: un esercizio fonemico (fluenza verbale) e un test visuo-spaziale (rotazioni mentali). RISULTATI Dal punto di vista neuropsicologico, il compito fonemico non ha rivelato differenze significative (p<0.05) tra i gruppi; al contrario, il gruppo di pazienti ha mostrato una riduzione delle prestazioni nel compito visuo-spaziale. I dati fMRI sono stati analizzati utilizzando due tecniche diverse. L'Independent Component Analysis (ICA) ha mostrato principalmente un volume all'interno della Dorsal Attention Network situato nel precuneo sinistro (area 7 di Brodmann) dove il gruppo di pazienti presentava una riduzione significativa della FC rispetto ai controlli. L'analisi dei grafi ha portato alla luce un numero di connessioni intra-emisferiche e intra-emisferiche di sinistra rivelate significativamente meno attive nei pazienti rispetto ai controlli, al contrario è stata osservata una sostanziale conservazione degli indici a livello di rete.

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8

Widerlöv, Birgitta. "Long-Term Functional Psychosis : Epidemiology in Two Different Counties in Sweden." Doctoral thesis, Uppsala University, Department of Neuroscience, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7466.

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This thesis is based on two independent studies, the first in Stockholm County (index year 1984; n=302), and the second, a replication and validation study, in Uppsala County (index year 1991; n=455).

The general aim was to study all individuals with Long-term Functional Psychosis (LFP) within the two counties of Sweden from an epidemiological perspective and to perform specific studies on a subgroup of individuals with schizophrenia. In the Stockholm study, the total one-year LFP prevalence was 5.3/1 000; in the the rural, suburban and urban areas it was 3.4, 5.6 and 6.6/1 000, respectively. The total one-year prevalence of LFP in Uppsala was 7.3/1 000; in the rural, peripheral city and central city areas it was 6.0, 7.0, and 8.7/1 000, respectively.

Within the non-schizophrenic subpopulation, a pronounced difference was demonstrated between the two studies with substantially higher prevalence rates in the Uppsala study. The schizophrenic subgroup in Uppsala was re-diagnosed using parallel diagnostic systems (DSM-III, DSM-III-R, DSM-IV and ICD-10), and reasonably comparable prevalence estimates were obtained.

In both studies antipsychotic drugs were most frequently prescribed for the patients with schizophrenia, and the doses were considered as low to moderate. In the Uppsala study the doses of antipsychotic drugs decreased with a longer duration of illness, while the opposite was found in the Stockholm study.

The increased mortality rate among patients with schizophrenia was mainly due to unnatural causes of death and cardiovascular diseases, particularly among males.

The main methodological differences between the two studies were in the sampling procedures. In the Uppsala study, a larger number of care facilities were screened, and a broader set of diagnostic criteria were used for identifying cases from different registers.

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9

Cloherty, Monique Elizabeth. "Confabulation in brain injury and in people with a functional psychosis." Thesis, University of Hertfordshire, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.431980.

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10

Widerlöv, Birgitta. "Long-term functional psychosis : epidemiology in two different counties in Sweden /." Uppsala : Acta Universitatis Upsaliensis, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7466.

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11

Kapasi, Masuma. "Cognitive function in first-episode psychosis : Infulences and outcomes." Thesis, Imperial College London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.520952.

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12

Achim, Amélie M. "Functional brain imaging of episodic memory in schizophrenia and first episode of psychosis." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=111847.

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Memory is one of the cognitive functions that is most affected in schizophrenia and memory dysfunctions have a major impact on the functioning and quality of life of these patients. Functional brain imaging can help us identify the brain structures that are affected during the performance of a memory task. Identifying these regions can help us identify the specific cognitive processes that are affected in schizophrenia. To this end, I performed a meta-analysis of published functional brain imaging studies of episodic memory in schizophrenia. This meta-analysis showed that the prefrontal cortex and the medial temporal lobes are the brain regions that are most consistently reported as being affected in schizophrenia during the performance of a memory task. Most studies however used a low-level baseline condition that did not target a specific cognitive process. In addition, they included patients with a long-term history of schizophrenia, leaving open the possibility that factors linked to illness chronicity could have influenced the pattern of results. Based on the insights gleaned from the meta-analysis, I performed a functional magnetic resonance imaging study of episodic memory encoding in patients with a first episode of a schizophrenia spectrum psychosis (FEP) and healthy subjects. Three processes known to be involved in memory encoding were targeted, namely associative processing, semantic associative novelty and encoding success. In healthy subjects, both associative processing and semantic associative novelty were associated with increased activation in the medial temporal lobes, with no interaction between these two variables. In people with FEP, encoding success and associative processing revealed intact patterns of prefrontal and medial temporal lobe activation. In contrast, semantic associative novelty was associated with a marked reduction in medial temporal activation. The identification of selectively intact and deficient processes involved in memory encoding has potential clinical relevance for the development of more focused cognitive remediation strategies.

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13

Borgå, Per. "Studies of long-term functional psychosis in three different areas of Stockholm county." Doctoral thesis, Umeå universitet, Psykiatri, 1993. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-99336.

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14

Armstrong, Victoria Diane. "Functional changes in neurons and glia following amphetamine-induced behavior sensitization." CSUSB ScholarWorks, 2003. https://scholarworks.lib.csusb.edu/etd-project/2168.

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15

Ranlund, S. M. "Biomarkers of brain function in psychosis and their genetic basis." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1493030/.

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Psychotic disorders, including schizophrenia and bipolar disorder, are amongst the most severe and enduring mental illnesses. Recent research has identified several genetic variants associated with an increased risk of developing psychosis; however, it remains largely unknown how these lead to the illness. This is where endophenotypes – heritable traits associated with the illness and observed in unaffected family members of patients – could be valuable. Endophenotypes are linked to the genetic underpinnings of disorders, and can help elucidate the functional effects of genetic risk variants. This thesis investigates endophenotypes for psychosis, with the overall aim of identify such biological markers, as well as to examine the relationships between different endophenotypes and their associations with genetic risk for psychosis. A family design has been used throughout, including patients with psychosis, their unaffected first-degree relatives, as well as healthy controls. In chapter 1, I review the endophenotype approach and those markers proposed for psychosis genetic research. Chapters 2 and 3 investigate whether different neurophysiological measures are potential endophenotypes for psychosis. In chapter 2, resting state EEG was studied and it was shown that risk groups, including unaffected relatives and people with an at-risk mental state, presented no abnormalities. This suggests that – rather than endophenotypes – the low frequency electrophysiological abnormalities seen in chronic patients in this study might be related to illness progression or long-term medication effects, and be more useful as biomarkers in non-genetic research. In chapter 3, I used dynamic causal modelling to investigate effective connectivity – the influence that one neuronal system exerts over another – underlying the mismatch negativity evoked potential, a marker of pre-attentive auditory perception. Results indicate that, compared to controls, both patients and their relatives show abnormalities of the excitability of superficial pyramidal cells in prefrontal cortex. Hence, this appears to be linked to the genetic aetiology of psychosis, and constitutes a potential endophenotype. Chapters 4 and 5 investigate several pre-identified endophenotypes for psychosis: Electrophysiological (the P300 event related potential), cognitive (working memory, spatial visualisation, and verbal memory), and neuroanatomical (lateral ventricular volume). In chapter 4, the associations between these endophenotypes were examined. Results showed that the P300 amplitude and latency are independent measures; the former indexing attention and working memory and the latter possibly a correlate of basic speed of processing. Importantly, individuals with psychosis, their unaffected relatives, and healthy controls all showed similar patterns of associations between all pairs of endophenotypes, supporting the notion of a continuum of psychosis across the population. Lastly, in chapter 5, polygenic risk scores – a measure of the combined effect of a large number of common genetic risk variants – were used to investigate the relationships between genetic risk for schizophrenia and bipolar disorder, and the endophenotypes studied in the previous chapter. Results showed that higher polygenic score for schizophrenia nominally predicts poorer performance on a spatial visualisation task; providing some evidence that the two traits share genetic risk variants as hypothesised. No other associations approached significance, possibly due to insufficient statistical power. However, as discovery samples grow, the use of polygenic scores is promising. This thesis has thus contributed to the field of mental health research by investigating key electrophysiological, cognitive and imaging endophenotypes for psychosis, as well as their genetic influences. Well defined and reliably measured endophenotypes are valuable in mental health research by clarifying the functional effects of identified genetic risk factors, and by providing ways of identifying groups of people with similar abnormalities, both within and between current diagnostic categories.

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16

Buchy, Lisa. "Clinical, neurocognitive, and structural and functional MRI correlates of insight in first-episode psychosis." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=110600.

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Background. Poor insight is primary symptom of psychosis that can be characterized along clinical and cognitive dimensions. Clinical insight describes ones awareness of illness, awareness of treatment need/efficacy, and ability to relabel unusual mental events, while cognitive insight reflects ones self-reflectiveness and self-certainty in beliefs. Purpose. Our overall aim was to map the psychopathological correlates and cognitive and neural systems underlying poor clinical and cognitive insight in FEP using behavioural analyses, and MRI-based cortical thickness, diffusion tensor imaging and functional imaging measurements.Methods. We carried out the following experiments: 1. Assessing the trajectory of clinical insight at multiple time points over the first year of a FEP 2–3. Mapping the extent of cortical thinning in FEP patients with poor clinical insight. 4. Analyzing the role of the hippocampus in cognitive insight in FEP 5. Analyzing the integrity of the fornix in relation to self-certainty in FEP. 6. Assessing the significance of delusional severity for cognitive insight in FEP. 7. Analyzing the role of source memory for cognitive insight in FEP using a virtual reality cognitive activation paradigm during fMRI data acquisition. Results. 1. Clinical insight improved concurrently with positive, negative and anxious symptoms between baseline and month 1. Five patient subgroups were discriminated: good, increasing, decreasing, moderate poor and very poor. 2–3. Cortical thinning was associated with clinical insight. 4. Verbal memory associated with self-reflectiveness, while hippocampal volume was associated with self-certainty. 5. Fornix integrity associated to self-certainty. 6. Delusions were associated with self-reflectiveness. 7. FES patients demonstrated statistically similar source memory performance to that of healthy controls. Despite this, within-group analyses revealed BOLD signal differences in frontal and parietal regions in correlation with higher self-reflectiveness and lower self-certainty in FES and controls during source memory recognition.Conclusions and significance. 1. Specific longitudinal insight trajectories appeared to be driving the observed associations between clinical insight and negative and depressive symptoms in the entire FEP cohort. 2–3. The findings suggest that the neural signature of clinical insight in FEP involves a network of semi-independent brain structures. 4–5. Structural deficits in the hippocampus and its circuitry, including fornix integrity, appear to be emerging as an intermediate phenotype for self-certainty in FEP. In individuals with a FEP, cognitive insight may rely on memory whereby current experiences are appraised based on previous ones. 6. Self-reflection may be important for delusion severity. 7. The disparate regional brain activity in FES might reflect the use of an alternate cognitive stratagem to achieve adaptive self-reflectiveness and self-certainty levels, or may reflect underlying neuropathology in frontal and parietal areas.
Contexte. Le manque d'auto-critique (insight) est un symptôme primaire de psychose qui peut être caractérisé sur les plans cliniques et cognitifs. L'insight clinique décrit la conscience qu'a une personne de sa maladie, la conscience du besoin ou de l'efficacité du traitement et l'habileté d'une personne à catégoriser des événements mentaux inhabituels, alors que l'insight cognitif représente la capacité de réflexion sur soi et le niveau de certitude par rapport à ses propres croyances. Objectif. Notre objectif général était de définir les corrélats psychopathologiques et cognitifs ainsi que les systèmes neuronaux impliqués dans le manque d'insight clinique et cognitif chez les premiers épisodes psychotiques (PEP) en utilisant des analyses comportementales ainsi que des mesures basées sur l'IRM comme l'épaisseur corticale, l'imagerie par tenseur de diffusion et l'imagerie fonctionnelle.Méthodes. Nous avons fait les expériences suivantes : 1. Évaluer la progression de l'insight clinique à plusieurs moments de la première année d'un PEP 2–3. Définir l'ampleur de l'amincissement cortical chez les patients PEP avec un manque d'insight clinique. 4. Analyser le rôle de l'hippocampe dans l'insight cognitif chez les PEP 5. Analyser l'intégrité du fornix en relation avec la certitude de soi chez les PEP. 6. Évaluer le rôle de la sévérité des délires par rapport à l'insight cognitif des PEP. 7. Analyser le rôle de la mémoire de la source dans l'insight cognitif chez les PEP en utilisant un paradigme d'activation cognitive en réalité virtuelle durant une acquisition de données d'IRMf.Résultats. 1. L'insight clinique s'est amélioré simultanément avec les symptômes positifs, négatifs et d'anxiété entre l'évaluation initiale et le premier mois. Cinq sous-groupes de patients ont été identifiés : bon, croissant, décroissant, modérément faible et très faible. 2–3. L'amincissement cortical était associé avec l'insight clinique 4. La mémoire verbale était associée avec la réflexion sur soi alors que le volume de l'hippocampe était associé avec la certitude de soi, indépendamment des effets de la mémoire verbale chez les PEP. 5. L'intégrité du fornix était associée à la certitude de soi. 6. Les délires étaient associés avec la réflexion sur soi. 7. Les patients PEP démontraient une performance de leur mémoire source similaire aux contrôles sains. Malgré ceci, les analyses à l'intérieur de chaque groupe ont révélé une différence du signal BOLD dans les régions frontales et pariétales en corrélation avec une plus grande réflexion de soi et une plus faible certitude de soi chez les PEP et les contrôles durant une tâche de reconnaissance de la mémoire source.Conclusions et importance. 1. La progression longitudinale spécifique de l'insight semble entraîner les associations entre l'insight clinique et les symptômes négatifs et dépressifs dans l'ensemble de la cohorte PEP. 2–3. Les résultats suggèrent que la signature neuronale de l'insight chez les PEP implique un réseau de structures cérébrales semi-indépendantes. 4–5. Les déficits structuraux de l'hippocampe et de ses circuits, incluant l'intégrité du fornix, semblent émerger en tant que phénotype de la certitude de soi chez les PEP. Chez les individus avec un PEP, l'insight cognitif pourrait reposer sur la mémoire puisque les expériences actuelles sont jugées sur la base des expériences précédentes. 6. La réflexion sur soi pourrait être importante pour la sévérité des délires. 7. L'hétérogénéité de l'activité des régions du cerveau chez les PEP peut refléter l'utilisation d'une stratégie cognitive alternative pour adapter la réflexion de soi ou la certitude de soi. Ceci pourrait aussi refléter une neuropathologie sous-jacente dans les régions frontales ou pariétales.

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17

O'Daly, Owen. "Investigating the Amphetamine Sensation Model of Psychosis using Functional Magnetiic Resonance Imaging in Humans." Thesis, King's College London (University of London), 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.498142.

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18

Tso, F., and 曹斐. "Longitudinal neurocognitive functions in First-episode psychosis: 24-month follow-up." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31227909.

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19

Clark, Lucy Victoria. "Exploration of the role of attachment in the relationship between trauma and distress in psychosis." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/8006.

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Background: Attachment literature indicates attachment status is related to trauma with associations between early trauma and insecure attachment. Links between psychosis and trauma have been established within the literature; however the precise nature of this relationship is still not fully understood. A systematic review was carried out to assess the state of the evidence pertaining to psychosis and attachment. Associations between insecure attachment and psychotic symptoms were identified. Other psychological correlates such as perceived parental care, attachment to services and interpersonal problems were found to relate to insecure attachment status. However due to the early stage of this area of research, small clinical sample sizes and heterogeneity of correlates investigated, firm conclusions cannot currently be drawn. Aim: The aim of this study was to investigate the relationship between trauma, attachment, reflective functioning (RF) and distress for people with psychosis with a view to further understanding these links and the clinical implications. Method: Participants with a diagnosis of psychosis were recruited and measures were completed with the principle investigator pertaining to trauma, attachment and distress in psychosis. Results: The majority of the sample reported insecure attachment and low RF and there were high levels of general, and more specifically, interpersonal trauma within the sample. Results indicated that early interpersonal trauma was associated with higher levels of emotional distress. Exploratory mediation analyses implicated anxious attachment in mediating the relationship between interpersonal trauma and distress. Discussion: The results indicate the need to consider early trauma histories and specifically interpersonal trauma and attachment in the context of emotional distress for people experiencing psychosis. Incorporating trauma and attachment based therapeutic approaches for people with psychosis is as relevant as it is for other trauma populations, where these approaches may be more routinely drawn on for formulation and treatment. Limitations of the methodological approach are considered along with suggestions for future research.

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20

Davies, Geoff. "A metacognitive account for the relationship between neurocognition and functional outcome in first-episode psychosis." Thesis, University of Sussex, 2016. http://sro.sussex.ac.uk/id/eprint/61167/.

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Neurocognitive and functional outcome deficits have long been acknowledged in schizophrenia and are considered a core feature of the disorder. Neurocognition has been found to account for functional disability to a greater extent than psychopathology however much of the variance in functional outcome still remains unexplained. How functional outcome is measured also requires clarification. By investigating the relationship between neurocognition and functional outcome in First-Episode Psychosis (FEP), much can be learnt about the trajectory of disability and the course of illness in schizophrenia. Metacognition, or thinking about thinking, has been proposed as a mediating variable between neurocognition and functional outcome. Despite different theoretical backgrounds, authors generally converge on there being higher-order, explicit, conscious metacognitive knowledge and lower-order, implicit metacognitive processes. How these relate to each other requires clarification. The prefrontal cortex (PFC) has been implicated in higher order thought and metacognitive processing, and deficits have been observed in PFC Grey Matter (GM) volume in schizophrenia. These metacognitive deficits may contribute to the relationship between cognitive ability and community functioning. A preliminary meta-analysis demonstrated that a moderate effect size is found between neurocognition and metacognition and a moderate effect size exists between metacognition and functional outcome. The present thesis investigated whether metacognition mediates the relationship between neurocognition and functional outcome in FEP (N=80). Path models were created to investigate the different relationships between neurocognition, metacognition and both capacity to perform everyday tasks and objective functioning in the community. A secondary Voxel-based Morphometry (VBM) analysis was also conducted investigating perceptual metacognitive accuracy and its relationship to GM volume in both FEP (N=41) and a matched healthy control sample (N=21). Current findings support the model that metacognition and negative symptoms mediate the relationship between neurocognition and functional capacity in FEP. Path models also demonstrated a significant mediation effect of metacognition between neorocognition and objective function, and functional capacity and objective function. Significant group differences were found between FEP and controls in perceptual metacognitive accuracy however no significant relationship was found between metacognition and GM volume in the PFC. The present thesis suggests that metacognitive deficits are present at first episode and may account for the relationship between cognitive ability and functioning in the community. Findings also suggest that cognitive remediation programmes may wish to focus on metacognition to maximise the transfer of cognitive skills to community functioning. The findings also suggest the presence of two metacognitive processing routes; explicit, declarable, higher-order knowledge and implicit, intuition-based, lower-order experience which can be accounted for by Nelson and Narens (1990) metacognitive model.

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21

Chiliza, Bonginkosi. "A prospective study of clinical, biological and functional aspects of outcome in first episode psychosis." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/97904.

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Thesis (PhD)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Prospective, longitudinal clinical studies in first-episode schizophrenia have become relatively commonplace over the past two decades or more and have provided a wealth of useful information regarding the clinical presentation, treatment, course and outcome of the illness. However, there remain several unanswered questions. The majority of the studies have been conducted in upper income countries using often costly medication with heterogeneous samples. While the overall outcome of patients showed some progress, there is room for improvement yet. The overall aim of the dissertation was to study the clinical, biological and functional aspects of outcome in first episode schizophrenia in a resource constrained setting. We conducted a prospective, non-comparative, longitudinal study over 12 months assessing the efficacy and tolerability of a cost effective, long-acting injectable antipsychotic (LAI; flupenthixol decanoate) combined with an assertive monitoring program (AMP) among first-episode schizophrenia patients. Efficacy was measured by examining rates of response, remission and relapse, as well as quality of life and social and occupational functioning. Tolerability of our intervention was assessed by measuring extrapyramidal symptoms, and weight and metabolic changes. We also examined the evolution of treatment refractoriness by studying the rates of non-response, and other associated predictor and outcome features. We found high rates of acceptance and adherence to the LAI and AMP. Seventy percent of our patients completed the 12 months of treatment. Treatment response was achieved by 82% of the participants and 60% achieved remission. Although 19% of our patients relapsed, the majority of the relapses were mild and did not require hospitalisation. Patients experienced significant quality of life and social and occupational functioning improvements. We found mild rates of extrapyramidal effects, present in only a third of our cohort. The majority of the extrapyramidal effects were treated with anticholinergics or propranolol. Only 3% of our patients developed transient dyskinesia over the duration of the study. However, our cohort gained considerable weight, with statistically significant increases in BMI (p< .0001) and waist circumference (p=0.0006). Our cohort also experienced significant deleterious changes to their lipid profiles. Of particular concern was the increase in triglycerides (p=0.03) and a significant decrease in high density lipoprotein (p=0.005) leading to a 91% increase in the triglyceride/high density lipoprotein ratio. With regards to emerging treatment refractoriness, 12% of our patients met our pre-defined criteria for non-response. Non-responders were younger and at baseline showed more prominent disorganised symptoms, poorer social and occupational functioning, poorer quality of life for psychological, social and environmental domains, more prominent neurological soft signs (NSS), and lower BMI. At endpoint the non-responders were characterised by higher levels of symptomatology in all domains; poorer functional outcome, poorer quality of life and greater cognitive impairments. They also had more prominent NSS and a lower BMI. The strongest predictors of non-response were prominent baseline NSS and poor early (7 weeks) treatment response. In conclusion, the combination of an LAI with an AMP may be an effective and safe intervention in firstepisode schizophrenia, and may be particularly suitable for resource-constrained settings. The risk of weight gain and metabolic syndrome associated with antipsychotic treatment in first-episode schizophrenia are not restricted to second generation antipsychotics and low-potency first-generation antipsychotics. Ensuring effective treatment for first episode schizophrenia patients is a global problem, and likely to be under-recognised in LMICs.
AFRIKAANSE OPSOMMING: Oor die afgelope twee dekades het toenemend meer longitudinale kliniese studies, wat eerste episode skisofrenie bestudeer, die lig gesien. Die studies het ‘n magdom van waardevolle inligtng oor die kliniese voorkoms, behandeling, verloop en uitkomste van die siekte opgelewer. Die meerderheid van die studies is egter in hoë inkomste ontwikkelde lande gedoen met pasiënte wat duur medikasie gebruik en hoofsaaklik in heterogene steekproewe. Alhoewel dit blyk uit hierdie studies dat daar oor die algemeen vordering gemaak word ten opsigte van die behandeling van pasiënte is daar steeds ‘n gebrek aan voldoende inligting oor die onderwerp veral in minder gegoede, ontwikkelende lande. Die oorhoofse doel van hierdie proefskrif is om binne ‘n hulpbron beperkte konteks die kliniese, biologiese en funksionele aspekte van pasiënt -uitkomste in eerste episode skisofrenie te ondersoek. Ons het ‘n longitudinale studie gedoen waarin ons die effektiwiteit en toleransie van ‘n enkele antipsigotiese medikasie vir 12 maande nagevors het. Die medikasie wat ons ondersoek het, is flupenthixol decanoate en word deur ‘n inspuiting gegee en die medikasie word dan geleidelik deur die liggaam geabsorbeer. As deel van die behandeling het ons pasiënte ook streng gemonitor. Ons het die effektiwiteit van die behandeling gemeet nagelang van hoe pasiënte reageer op die behandeling, hoeveel pasiënte in remissie gaan en terugval, en ook pasiënte se kwaliteit van lewe en hulle sosiale en beroepsfunksionering. Ons het toleransie gemeet nagelang van pasiënte se gewig en metaboliese verandering sowel as die voorkoms van medikasie geïnduseerde newe-effekte. Verder het ons pasiënte wat nie op medikasie gereageer het nie ondersoek sowel as die aspekte wat moontlik hiernee verband hou. Ons het bevind dat die meerderheid van pasiënte hulle medikasie getrou geneem het en ook die streng monitering aanvaar het. Sewentig persent van die pasiënte het hulle 12 maande behandeling voltooi, 82% het op die medikasie gereageer en 60% het in remissie ingegaan. Alhoewel 19% van die pasiënte teruggeval het, was dit nie so ernstig dat ons hulle moes hospitaliseer nie. Pasiënte het beduidende verbetering ten opsigte van hulle kwaliteit van lewe en sosiale en beroepsfunksionering getoon. Ons het slegs ‘n gematigde mate van medikasie geïnduseerde newe-effekte opgemerk en alleenlik by ‘n derde van die kohort. In die meerderheid van gevalle het ons die newe-effekte met anticholinergics of propranolol behandel. Slegs 3% van die pasiënte het gedurende die verloop van 12 maande die kondisie transient dyskinesia ontwikkel. Ongelukkig het ons kohort geweldig baie gewig opgetel en die toename in pasiënte se BMI (p< .0001) en middellyf omtrek (p=0.0006) was statisties beduidend. Ons het ook bevind dat veranderinge in ons kohort se lipied profiele kommerwekkend is veral as in ag geneem word dat die toename in trigliseriede (p = 0,03) en die beduidende afname in die hoë digtheid lipoproteïen (p = 0,005) gelei het tot ‘n 91% verhoging in trigliseriede: hoë digtheid lipoproteïen verhouding.

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22

Bois, Catherine. "Investigation in the relationship between childhood adversity and cognitive function in psychosis and individuals at clinical high risk of psychosis." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33089.

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Background An increasing body of research is suggesting that childhood trauma and adversity may be associated with various adverse mental health outcomes, including psychosis. Cognitive functioning is often compromised in psychosis, and research has shown that there may be a link between early trauma and cognitive impairment in people with psychosis. No systematic review of the literature of this link has been undertaken, and very few studies have examined samples of individuals at high clinical risk for psychosis, to assess whether the potential link between adversity and cognitive functioning exists, without the confounding factors of length of illness, antipsychotic medication and chronicity of symptoms. Method The systematic review of all relevant electronic databases investigates the research to date on the association between childhood adverse experiences and cognitive ability in psychosis, and the conclusions that can be drawn from the existing literature, taking into account relevant considerations regarding sample, methodology and statistical analysis. The subsequent empirical study utilizes a sample at clinical high risk of developing psychosis, and a healthy control group to investigate whether any putative association in specific domains of cognitive functioning, or global cognitive ability and childhood adversity exist in those at clinical high risk, compared to controls. Results The systematic review indicated that at present, the literature looking into childhood adversity and cognitive ability in relation to psychosis is heterogeneous, with some studies finding that this association only occurs in patients, whilst others suggest it only occurs in the control groups. Some studies found it to be specific to certain cognitive domains, whilst others suggest it was a more global impairment. Methodology, samples and analysis differed considerably across studies, and likely contribute to the heterogeneity of the literature. The empirical paper showed a significant interaction effect between group (high risk versus controls) in the high childhood adversity group, in relation to global cognitive ability. Interestingly, this was not related to psychotic symptom severity or distress. Conclusion Several limitations of the existing studies limit the conclusions that can be drawn from the existing evidence regarding the link between childhood adversity and cognitive ability, and future research in prodromal samples is essential. The empirical study showed that there is a link between childhood adversity and cognitive ability in those at clinical high risk of developing psychosis, before disorder onset, that is not present in controls. This suggests that this may form a vulnerability in those at high risk for psychosis, rather than a more general mechanism present in the typical population.

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23

Brennan, Anne Margaret. "Cognition In First Onset Schizophrenia: Mapping Relationships Between Task Performance, Brain Function And Symptoms." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17570.

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Functional dysconnectivity has been proposed as the cause of schizophrenia. This thesis proposes a model with increased neural synchrony in the gamma band (30-100 Hz) as the underlying physiological mechanism responsible for this dysconnectivity. The model is tested by examining cognition, electroencephalogram (EEG) gamma synchrony, and functional magnetic imagining (fMRI) functional connectivity, and their interrelationships, in participants with first onset schizophrenia (FOS) and matched controls. All responses were elicited by a standard paradigm of attention – the Continuous Performance Test (CPT). This is the first direct comparison across these units of analysis in schizophrenia using the same paradigm. FOS showed impaired CPT cognitive performance (best measured by accuracy; n=75). The modulation of gamma synchrony to task-evoked changes was reduced in FOS (n=59), in the context of generally higher intrinsic synchrony, particularly in frontal regions. FOS (n=22) showed abnormal fMRI functional connectivity, measured from a DLPFC seed, with decreased connectivity to the inferior parietal cortex and increased connectivity to the dorsal anterior cingulate cortex. These findings support a model of schizophrenia as a disorder of excessive intrinsic brain connectivity with a failure to recruit appropriate task-induced activity. However, when interrelationships were examined pair-wise (EEG-cognition, fMRI-cognition, EEG-fMRI), they were more complex than hypothesized and did not integrate well into the model. A case-series (n=15 FOS; n=13 controls) examining interactions among all three measures provided further evidence of this complexity. The results highlight the importance of integrating across different units of analysis using the same task in the same participants, as it was the relationships among measures that challenged the model. The findings undermine schizophrenia simply as a disorder of abnormal functional connectivity caused by aberrant gamma synchrony.

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24

Thornton, Katy. "Clinical and non-clinical auditory verbal hallucinations : a psychological and functional imaging study of the psychosis continuum." Thesis, Bangor University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.516115.

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25

Lieslehto, J. (Johannes). "Early adversity, psychosis risk and brain response to faces." Doctoral thesis, Oulun yliopisto, 2018. http://urn.fi/urn:isbn:9789526220659.

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Abstract Schizophrenia and other psychotic disorders are severe and disabling mental disorders that break out during early adulthood, often when a person is in his/her early 20s. Furthermore, functional decline in many cognitive areas, including the ability to communicate in social interactions and impaired facial expression recognition, is typical to patients with schizophrenia. Understanding the risk factors of psychosis is essential as these disorders may be more amenable to treatment in their early stages. However, recognition of those at the highest risk of psychosis is challenging as no definitive biomarkers are available. Functional MRI is a promising tool that can potentially identify neural signals relating to the individual’s risk of psychosis onset. Psychotic disorders are etiologically heterogeneous disorders — both environmental and genetic factors have been linked to the onset of psychotic disorders. The most influential risk factor for a psychotic disorder is familial risk with genetic loading. The present study examines whether familial risk of psychosis (FR), the polygenic risk score for schizophrenia (PRS) and early adversity associate with brain response to faces. We used fMRI to measure blood oxygen level dependent (BOLD) response to faces. Our study showed that FR associated with deviant prefrontal cortex BOLD responses. In addition, we detected that interregional BOLD signal and grey matter volume varied as a function of PRS; the lowest functional and structural covariance was detected in individuals with high PRS. We also detected that early adversities associated with brain response to faces and that this association varied as a function of glucocorticoid receptor gene expression. Our findings indicate that the above risk factors of psychosis associate with brain response to faces
Tiivistelmä Skitsofrenia ja muut psykoosisairaudet ovat vakavia mielenterveyden häiriöitä, jotka puhkeavat usein nuorella aikuisiällä. Eräs tyypillinen piirre psykoosisairauksille on vaikeus tunnistaa muiden ihmisten kasvonilmeitä. Psykoosisairauksien riskitekijöiden ymmärtäminen on tärkeää, sillä hoito tehoaa parhaiten sairastumisen alkuvaiheessa. Suurimmassa psykoosivaarassa olevien henkilöiden tunnistaminen on kuitenkin haastavaa, sillä luotettavia tautiin liittyviä biomarkkereita ei ole saatavilla. Toiminnallinen magneettikuvaus (fMRI) on lupaava työkalu, jolla saattaa olla tulevaisuudessa käyttöarvoa psykoosivaaraan liittyvien aivomuutosten tunnistamisessa. Etiologialtaan psyykoosisairaudet ovat heterogeenisiä: sekä ympäristö että perinnölliset tekijät vaikuttavat yksilön sairastumisriskiin. Voimakkain riskitekijä on suvullinen psykoosialttius. Tässä osajulkaisuväitöskirjassa tutkitaan suvullisen psykoosialttiuden, skitsofrenian polygeenisen riskipisteen (PRS) sekä varhaisten vastoinkäymisten yhteyttä aivojen kasvonilmeitä tulkitsevaan järjestelmään. Tutkimuksessa on hyödynnetty fMRI-kuvausta kasvonilmestimuluksen aikana. Tutkimuksessamme suvullinen psykoosialttius oli yhteydessä etuotsalohkon fMRI-signaalimuutoksiin. Tämän lisäksi havaitsimme, että kasvonilmejärjestelmän fMRI-signaalin ja harmaan aineen kovarianssi oli yhteydessä PRS:ään: matalin aivoalueiden välinen korrelaatio havaittiin henkilöillä, joiden PRS oli korkea. Havaitsimme myös, että varhaiset vastoinkäymiset ovat yhteydessä kasvonilmeiden aikaansaamiin aivovasteisiin. Tämä assosiaatio oli myös yhteydessä glukokortikoidireseptorin geenin ilmentymiseen. Väitöskirjan löydökset viittaavat siihen, että edellä mainitut psykoosin riskitekijät ovat yhteydessä kasvonilmeitä tulkitsevaan järjestelmään

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26

Haworth, Elke Johanna. "Investigating the relationship between the failures of inhibitory processes in psychosis and schizotypy : experimental and functional neuroimaging studies." Thesis, King's College London (University of London), 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.408218.

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27

Le, Geyt Gabrielle. "Discontinuing neuroleptic medication for psychosis : a systematic review of functional outcomes and a qualitative exploration of personal accounts." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/discontinuing-neuroleptic-medication-for-psychosis-a-systematic-review-of-functional-outcomes-and-a-qualitative-exploration-of-personal-accounts(3bf677c2-81f1-40b9-bc07-76d1b578ee2f).html.

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This thesis sought to explore the phenomenon of discontinuing neuroleptic medication for psychosis. It comprises three standalone papers. Papers one and two have been prepared for submission to journals and in accordance with the journal guidelines. Paper one is a systematic literature review synthesising studies investigating the association between neuroleptic discontinuation and functional outcomes. Databases were systematically searched and thirteen studies were included in the review. Evidence regarding the association between discontinuation from neuroleptic medication and functional outcomes was mixed. Findings are limited by the scarcity of evidence, diversity in the study methods and designs used, and methodological and design quality issues. Paper two is a qualitative study exploring personal accounts of making choices about neuroleptic medication, specifically considering decisions to discontinue. Twelve participants were interviewed and a constructivist grounded theory approach was used to analyse transcripts. The findings suggest that making sense of choices relates to a continuation-discontinuation spectrum and involves three interrelated tasks. The tasks are: forming a personal theory of the need for, and acceptability of, neuroleptic medication; negotiating the challenges of forming alliances with others; and weaving a safety net to safeguard wellbeing. A theoretical model explaining the processes involved in the tasks and the mediating factors is presented and discussed. The clinical implications of the findings are discussed with reference to existing literature. Paper three is not intended for publication and is a critical review of the research process, in which the strengths and weaknesses of the systematic review and empirical study are evaluated. Personal and professional reflections on the experience of conducting a systematic review and an empirical qualitative study are discussed and the implications of the research for future clinical practice and research are considered.

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MacBeth, Angus M. "The function of attachment in first episode psychosis : a theoretical integration and clinical investigation." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/522/.

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Abstract: Section I - Introduction: The thesis explores the value of attachment theory as a framework for understanding the onset of, and adaptation to the experience of psychosis. The first section of the thesis establishes the clinical and theoretical context from which this line of enquiry arises, starting with a brief historical overview of the clinical approaches towards psychosis, including the diagnosis of schizophrenia, as a nosological entity (Chapter 1). Particular attention is drawn to the role of affect in psychosis, following Bleuler’s (1911/1950) conceptualisation of the splitting of cognitive and affect processes in the diagnosis of schizophrenia. The late 20th century growth of early intervention for psychosis, a psychologically informed service model, is discussed, in order to contextualise the service model explored for the second empirical study in the thesis. The parameters of the onset of psychotic difficulties, and subsequent adaptation to the experience of psychosis are then discussed (Chapter 2). Following this, the current literature on premorbid (i.e. before the onset of psychotic difficulties) functioning in psychosis and duration of untreated psychosis (DUP) is reviewed. The data finds no significant relationship between DUP and premorbid adjustment, and suggests that the role of social and academic functioning has been undervalued, particularly with regard to negative symptomatology and quality of life, with poorer adjustment relating to increased negative symptomatology and poorer quality of life. The importance of adolescent premorbid functioning is also highlighted. As premorbid adjustment concerns functioning prior to the onset of psychotic symptomatology, the review suggests scope for a reappraisal of the role of psychodevelopmental factors in psychosis (Chapter 3). This forms the rationale for viewing attachment theory as a theory par excellence in forwarding a psychodevelopmental understanding of psychosis, particularly given the relevance of contemporary perspectives on attachment theory (focussing on insecure attachment representations) in aiding the understanding of psychopathology in general (Chapter 4). Concluding the first section, a theoretical integration offers a framework for applying the principles of attachment theory, and the related constructs of mentalisation and affect regulation (e.g. Fonagy, Gergely, Jurist & Target, 2002) to the study of psychosis (Chapter 5). In particular the relevance of attachment and mentalisation to help-seeking, adaptation to psychosis and psychotic phenomenology is highlighted. It was hypothesised that secure attachment would associate with shorter DUP and better engagement, compared to insecure attachment classifications. Higher levels of mentalisation (operationalised as Reflective Function, RF) were also hypothesised to associate with shorter DUP, better help-seeking and better adjustment. Secure attachment was hypothesised to associate with higher RF. Section II – First Empirical study The second section of the thesis (Chapter 6) presents a short test of the theoretical validity of applying attachment theory to psychosis, using an analogue study to investigate the role of attachment in the phenomenology of paranoia and hallucinations. The results suggest attachment and a strategy of interpersonal distancing predict higher levels of paranoia, whereas hallucinatory phenomena were predicted by latent constructs representing interpersonal dependence and avoidance strategies (including attachment anxiety and avoidance). Section III – Second Empirical study The third section of the thesis builds on the first study by exploring the role of attachment in a clinical sample of individuals in the first year of treatment for a first episode psychosis, recruited from early intervention services in Glasgow and Edinburgh. The study utilises a cross-sectional cohort design (Chapter 7). The sample is characterised in terms of symptomatology, quality of life, DUP, help-seeking, premorbid adjustment, psychological variables, attachment states of mind (using the AAI) and mentalisation (Chapters 8). Premorbid adjustment and DUP are included to facilitate investigation of the relationships outlined in Chapter 3. Levels of psychotic symptomatology and the median DUP were all comparable with contemporary FEP cohort studies. Contrary to the findings of Chapter 3, results of the study with regard to premorbid adjustment suggest that this construct is significantly correlated with DUP, particularly in the social domain, in the direction of poorer adjustment associating with longer DUP,. Poorer premorbid social adjustment was significantly associated with greater negative symptoms and greater general psychopathology. Poorer premorbid adjustment was not associated with help-seeking, but was associated with poorer engagement with services after initiation of treatment. Longer DUP was not associated with greater positive symptomatology, or poorer engagement, but was associated with more help-seeking (Chapter 9). Attachment and mentalisation (RF) was investigated in a sub-sample of the main cohort. In contrast to chronic psychosis samples, both secure and insecure Attachment classifications were found in the FEP sample. Both secure and insecure/preoccupied attachment classifications were associated with higher RF. Attachment and RF were not related to psychotic symptomatology. However, higher RF was associated with poorer psychological quality of life. No significant relationships emerged between attachment and premorbid adjustment, DUP or help-seeking. No relationships between these variables emerged for RF. Attachment (but not RF) was significantly related to engagement, with secure attachment being associated with better engagement, and insecure/preoccupied attachment being associated with poorer engagement (Chapter 10). Section IV – Discussion The thesis represents a comprehensive assessment of theoretical links between attachment and psychosis, encompassing both phenomenological and clinical variables. The analogue study demonstrates the validity of the link between attachment and psychotic phenomenology, albeit limited by the use of self report measures of attachment. The clinical study is the first characterisation in Scotland of an FEP sample recruited from an early intervention cohort. The limitations of the clinical study are discussed in terms of small sample size, risk of Type I and II errors, and possible selection bias with regard to the attachment sub-sample. The low incidence of Unresolved attachment representations is also acknowledged. Theoretical implications of both studies are discussed in terms of the repositioning affect as an important factor in psychosis and the role of psychodevelopmental factors (including attachment, mentalisation and premorbid adjustment) in influencing onset and adaptation to psychosis. Clinical implications are discussed with regard to possible links with recovery trajectories, integrating attachment principles into treatment, and links to primary prevention of mental health problems in general (Chapter 11).

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29

Strömberg, Gunvor. "Serious mental illness : early detection and intervention by the primary health service." Doctoral thesis, Umeå universitet, Psykiatri, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-312.

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Background – People with functional impairments have unmet needs and they are not given the support and service they are entitled to. According to international studies, early measures and treatment may slow down the outbreak of mental illness and relieve its course. Aims - To elucidate and compare both somatic poor health and social needs of people with either physical or mental functional impairments in a rural district, and to explore and compare how different personnel in the primary health care service and psychiatric services are able to detect early signs of psychosis. Moreover, to find out how early signs of psychosis are detected in primary health services, and to explore the patients’ pathways to the GPs. Methods – In studies I and II, people with severe functional impairments were offered a screening health examination followed by an interview. Three vignettes were presented to personnel in the primary health care service and the psychiatric services in study III. The participants were asked to detect any signs and symptoms of psychosis in the vignettes. In studies IV and V, notes in primary health care records were studied during a period of two years and six months, respectively, before a diagnosis of psychosis was made by the general psychiatric services. Results – People with severe functional impairments had poorer health and more problems with their ADL (Activities of Daily Life), economy/work and Quality of Life than people in general. Among the groups studied, people with mental impairments had the poorest living conditions. There were no differences between the participants in study III regarding sex, age and occupation; and the participants detected the signs and symptoms in the vignettes to a high degree (75% of all signs and symptoms). In all, 152 patients (22 with schizophrenia/ schizoaffective disorders, 41 with schizophrenia preceded by other psychotic disorders and 89 with persisting psychiatric disorders) with the diagnosis of psychosis made by the general psychiatric services were included in study IV and V. There were notes in 77% of the primary health records during the two-year study period, and 70% of these notes were about psychiatric signs and symptoms, which means that the GPs detected signs and symptoms of psychosis in 2/3 of the cases. The analysis of the patients’ visiting patterns to GPs showed that many patients did not visit their “own” primary health care centre or their “own” GP. Furthermore, many patients had no contact with the primary health care service at all, and the subgroup with schizophrenia/schizoaffective disorders visited the primary health care service less frequently than the other groups. Main conclusion – People with severe functional impairments must be granted regular contacts with a GP, whose role must be: to identify and motivate the patients; to detect when there are needs for care and social needs; to function as a representative for the patients; to inform the patients about their rights and to guide them to other social or health authorities. The GPs detected early signs and symptoms of an emerging psychosis to a high degree, which would make early intervention possible. The more visits to the GPs, the more symptoms were detected, and out of all signs and symptoms with psychiatric content noted, the GPs would have suspected an emerging psychosis in almost every second patient who visited them. To detect early signs and symptoms of psychosis is difficult, and whenever in doubt, primary health care personnel must be able to consult psychiatric professionals. Otherwise we may miss the opportunity to intervene in an early phase of the illness. Additional training could also mean better understanding and earlier detection of people at risk of an emerging psychosis.

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30

Chan, Chung-ling Pansy, and 陳鍾靈. "The long-term effects of yoga and aerobic exercise on cognitive function and clinical symptoms in early psychosis : a follow-up randomized control trial." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206585.

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Background: A study of the impact of yoga and aerobic exercise and psychosis was conducted in 2012 by Lin et al., from The University of Hong Kong. The study indicated significant improvement in the aspects of physical fitness, cognitive functions, psychosocial and emotional functioning in patients with psychosis after a 12-week yoga or aerobic intervention program. Long-term effect of exercise intervention, however, had yet been determined. The aim of the present study was to evaluate the long-term effects of yoga and aerobic exercise on cognitive functioning and clinical symptoms in early psychosis. Patients who originally participated in Lin et al.’s 2012 study were recruited and re-assessed in this current 18-month follow-up study. Methods: Two intervention groups (yoga and aerobic exercise group) and one control group (wait-list control group) of a total 57 subjects from the initial study were recruited in this follow-up study. Cognitive functioning and clinical symptoms were assessed at three time points (T1:Baseline, T2:12-week, T3:18-month). Results: No significant changes or significant deterioration were found in cognitive functioning, clinical symptoms and depression between T2 (12-week) and T3 (18-month) in both intervention groups (yoga and aerobic group). Significant improvement of clinical symptoms was observed in wait-list control group at T3. Conclusions: Although there is no significant finding in this current study, it is still recommended that further study on the relationship between physical exercise intervention and psychosis should carried out in order to explore other adjunct, and especially low cost, treatment to antipsychotics in treating people with psychosis.
published_or_final_version
Psychological Medicine
Master
Master of Psychological Medicine

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31

Braehler, Christine. "An explorative study of processes of reflective function in adaptation to psychosis in young adults." Thesis, University of Edinburgh, 2007. http://hdl.handle.net/1842/23721.

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Psychological capacities for affect regulation and reflexive function, which develop in the context of early attachment relationships, may be critical in influencing adaptation to psychosis. Objectives: A primarily qualitative mixed method design was employed to pursue two research questions: 1) How do young people adapt to psychosis? 2) How do processes of reflective function influence the adaptation process? Methods: Two interviews were conducted with each of the 8 young people (aged 18 to 21) who had experienced clinically significant psychosis. To rate the level of reflective function with regard to attachment states of mind (attachment RF) the Adult Attachment Interview was administered. Grounded theory methodology was used to investigate young people’s experience of adaptation to psychosis and the level of reflective function in their accounts (adaptation RF). Results and Discussion: Two main themes relating to adaptation and adolescent individuation emerged. Moderate attachment and adaptation reflective function were linked to primarily positive adjustment and successful individuation following psychosis. Impaired attachment and adaptation reflective function were associated with unresolved adaptation and failed individuation post-psychosis. Conclusion: Level of reflective function appeared to moderate adaptation and individuation processes post-psychosis and should be considered in the delivery of psychological therapies.

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Rougeaux, Marie. "Optimisation des méthodes de créativité utilisateurs : le contrefactuel comme approche psycho-ergonomique de la pensée innovante." Thesis, Paris 8, 2017. http://www.theses.fr/2017PA080062.

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La créativité occupe une place centrale dans la conception. Dans une perspective de conception participative, de co-conception, cette créativité est d’autant plus importante qu’elle est celle des futurs utilisateurs, permettant alors d’aboutir à de l’innovation utile. Notre thèse est qu’il est possible d’améliorer la pensée innovante des utilisateurs en quantité (nombre de propositions) et en qualité (degré d’originalité des propositions) en ayant une méthode d’interrogation des participants-utilisateurs basée sur le contrefactuel. En s’intéressant à la Créativité-Utilisateur dans les processus de co-conception sous l’angle de l’optimisation de ces processus, cette thèse s’inscrit dans une approche psycho-ergonomique de l’innovation avec l’objectif d’étudier la possibilité de favoriser la créativité chez les utilisateurs grâce à l’utilisation du raisonnement contrefactuel.Basée sur un modèle de l’apport du contrefactuel à la créativité et à l'innovation, notre hypothèse générale est que (i) la fixité fonctionnelle est un obstacle cognitif majeur dans des tâches nécessitant la créativité mais (ii) elle peut être contrariée par l’utilisation du raisonnement contrefactuel. Ainsi, de la forme « si [OBJETi] alors [pour ACTIONi ] », - par exemple « si Boîte d’allumettes alors Pour Allumer du feu » -, la fixité fonctionnelle serait contrariée en demandant aux participant d’envisager le cas où « si [OBJETi] et [ NON pour ACTIONi ] alors [pour quelles AUTRES ACTIONS] » par exemple « si Boîte d’allumettes et non Pour Allumer du feu ; alors Pour Quoi faire d’autre ? ». En appliquant cette consigne, on devrait voir émerger plus d’idées créatives que dans des tâches habituelles de production d’idées innovantes. La thèse restitue la menée de série de six études, avec la participation d’utilisateurs finaux adultes et enfants, en situation de co-conception créative, allant du plus conceptuel (concevoir les propriétés sur de futurs objets) au plus pratique (la réalisation d’un prototype). Les deux premières études montrent l’apport de la pensée contrefactuelle à la technique de l’entretien semi-direct de recherche (sections 1.1 et 1.2) lorsque des items contrefactuels y sont intégrés. La deuxième et la troisième étude évaluent l’apport de la pensée contrefactuelle à la technique du Focus Group (sections 2.1 et 2.2) ; des items contrefactuels étant intégrés au guide des questions adressées au Focus Group. La quatrième et la cinquième étude analysent l’apport de la pensée contrefactuelle au Brainstorming (sections 3.1 et 3.2) en intégrant des contextes contrefactuels lors des séances de brainstorming et de brainwriting.En résumé, les travaux de thèse mettent en évidence que l’utilisation du raisonnement contrefactuel dans des tâches de créativité amoindrit la fixité fonctionnelle relative à une catégorie en optimisant la production d’idées créatives issues d’autres catégories
Creativity has a core function in design. Creativity is even more important in the perspective of a participatory design, «co-design», when it comes from future users as it leads to useful innovation. By focusing on users’ creativity in the co-conception processes in terms of the optimization, this thesis is part of a psycho-ergonomic approach to innovation with the objective of studying the possibility of fostering creativity among users. Our proposal is that it is possible to improve users' innovative thinking in quantity (number of proposals) as well as in quality (degree of originality of the proposals) by using a counterfactual-based method for participant-user queries.Based on a model of counterfactual contribution to creativity and innovation, our general assumption is that (i) functional fixity is a major cognitive obstacle in tasks requiring creativity and (ii) functional fixity may be counteracted by the use of counterfactual reasoning. Thus, from rules such as "if [OBJETi] then [for ACTIONi]" - (for instance "if Matchbox then to ignite"), functional fixity would be thwarted by asking participants to consider the following counterfactual " If [OBJETi] and [NOT for ACTIONi] then [for what OTHER ACTIONS] (for instance " if Matchbox and not to ignite; Then for what else? "). By applying this guideline, more creative ideas should emerge than in usual tasks of producing innovative ideas.The thesis is reporting a serie of six studies, with the participation of adult and child end-users embedded in creative co-design situations, ranging from conceptual (designing functional and procedural properties on future objects) to the most practical (the making of a prototype). The first two studies show the contribution of counterfactual thinking to the technique of semi-directed research interviewing (sections 1.1 and 1.2) when counterfactual items are integrated into it. The second and third studies evaluate the contribution of counterfactual thinking to the Focus Group technique (sections 2.1 and 2.2) with counterfactual items included in the questions list. The fourth and fifth studies analyze the contribution of counterfactual thinking to Brainstorming (sections 3.1 and 3.2) by integrating counterfactual contexts during brainstorming and brainwriting sessions.In summary, the thesis works show that the use of counterfactual reasoning in tasks of creativity reduces the functional fixity relative to a category by optimizing the production of creative ideas coming from other categories

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Wright, Abigail. "Developing a dynamic model of metacognitive influences on anomalous experiences and functional outcome in young people with and without psychosis." Thesis, University of Sussex, 2019. http://sro.sussex.ac.uk/id/eprint/81223/.

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Beck and Rector (2005) proposed a model of functional outcome in schizophrenia, suggesting the path between neurocognition and functioning is mediated by functional capacity and cognitive processes. These cognitive processes include defeatist performance beliefs, self-stigma and, most recently, metacognition, considered 'thinking about thinking'. Metacognition has been proposed to work in a hierarchy between the object- and meta-level, outlined within Nelson and Narens (1990) model, including several metacognitive components: metacognitive ability, experience and efficiency, connected by metacognitive processes. Firstly, this thesis investigated how different metacognitive components may interact dynamically and predict both what people do in their everyday lives (functional outcome) and how people feel about their everyday lives (subjective recovery outcome) in First Episode Psychosis (N=62), compared to healthy controls (N=73). Following this, this thesis examined the role of metacognition in predicting functional outcome across a three-year period, in FEP (N=26). Finally, it was suggested that metacognition may be expanded to include the way one thinks about oneself through important memories, e.g. self-defining memories (SDMs). The role of SDMs as an additional mediator between neurocognition and functioning in psychosis (N=71) was investigated. Next, using only one of the metacognitive components: metacognitive efficiency, this thesis explored whether this component could be used to explain the presence of anomalous experiences. Anomalous experiences refer to a rich number of various psychic phenomena, including anomalous self-experiences and anomalous perceptual experiences, leading to anomalous delusional beliefs. Initially, this thesis developed and piloted two metacognitive tasks in healthy student sample (N=125). Next, these tasks were used to examine the relationship between anomalous experiences and metacognitive efficiency within the first two samples (N=135): FEP group (N=62) and healthy control (N=73). Current findings demonstrated a role for metacognitive ability in predicting both functional outcome and subjective outcome in FEP, cross-sectionally, and in predicting functional outcome across three years. Alongside this, holding specific self-defining memories was shown to predict functional outcome, independent of neurocognition and metacognition, in FEP. However, no significant association was demonstrated between anomalous experiences and metacognitive efficiency, instead anomalous self-experiences were associated with auditory perceptual biases. This thesis highlights the importance of enhancing metacognitive ability, alongside neurocognitive ability and SDMs, in order to improve functioning.

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Stumpenhorst, Katharina. "Separate and interactive effects of catechol-o-methyltransferase and tetrahydrocannabinol on frontostriatal dopamine function." Thesis, University of Oxford, 2017. http://ora.ox.ac.uk/objects/uuid:e8eb9eba-0e32-4b30-8349-c2678207f547.

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The frontostriatal dopamine system modulates brain function and is affected by both genetic and environmental factors. Dysfunction of this system is associated with many pathological states, including schizophrenia. The enzyme catechol-O- methyltransferase (COMT) metabolises dopamine and its gene contains a polymorphism (Val¹⁵⁸Met) that affects enzyme activity. Delta-9- tetrahydrocannabinol (THC), the main psychoactive component of cannabis, has been suggested to interact with this polymorphism to increase the risk for psychosis and cognitive impairments. Dopaminergic mechanisms are a plausible candidate for mediating this interaction. I used microdialysis coupled with high performance liquid chromatography (HPLC) to examine the effects of THC on extracellular dopamine and its metabolites in the nucleus accumbens, dorsal striatum and medial prefrontal cortex (mPFC) in freely moving mice. Following acute COMT inhibition with tolcapone, THC increased extracellular dopamine levels in the nucleus accumbens in tolcapone-, but not in vehicle-, treated mice. The introduction of the low activity Met allele into the COMT gene produced a highly specific, novel mouse model of the Val158Met polymorphism. In contrast to the effects of acute COMT inhibition, the Met allele protected against THC-induced changes in accumbal dopamine. No interactive neurochemical effects were observed in the dorsal striatum (pharmacological and genetic study) or in a preliminary study of the mPFC (genetic study only). On a progressive ratio task measuring motivational salience, the direction of the interactive effect between COMT genotype and THC differed between 2 independent cohorts and provided tentative leads that stress/arousal-dependent effects on COMT may have a confounding effect. My data provide evidence that COMT activity modulates the effect of THC on accumbal dopamine function, and suggest the mechanism through which this interaction is mediated differs between acute and lifelong reduction in COMT activity. Through the interactive effect on the dopaminergic system, the data provide a potential mechanism for the reported interaction between COMT and cannabis/THC in determining psychosis risk and cognitive impairments.

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Demetriou, Eleni Andrea. "An empirical evaluation of executive function in Autism Spectrum Disorder." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/20827.

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Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterised by social impairment and restricted/repetitive behaviours. It is associated with significant disability and poor life outcomes with increasing interest in the factors that contribute to this disability. A significant body of research has focused on investigating the role of executive function (EF) in ASD. This thesis presents a series of studies that aim to advance the knowledge of EF in ASD. The studies considered factors that may moderate EF and investigated the role of EF in diagnosis and predicting disability. The research cohort comprised of youth and adults with ASD. Comparisons were made with clinical groups diagnosed with Social Anxiety Disorder and Early Psychosis. The first empirical study presented a meta-analysis of the extant literature on EF in ASD across the lifespan. Empirical studies 2 and 3, explored the role of moderators on EF including sex differences and affective states. Empirical study 4, examined the role of EF in differential diagnosis and in predicting disability. The final study utilised a machine learning paradigm and examined whether EF discriminated the ASD cohort from the comparison groups. The research results point to broad executive dysfunction in ASD not influenced by moderator variables or sex differences. Affective states moderated EF across all comparison groups, suggesting a transdiagnostic influence. EF differentiated the ASD cohort from comparison groups and was a unique predictor of disability for the ASD group only. The studies presented in this thesis highlight the importance of a multifaceted evaluation of EF in ASD. This will allow evaluation of unique and shared factors influencing disability outcomes, acknowledge the contribution of mental health factors to EF and facilitate targeted intervention and remediation programmes. Importantly, the cross diagnostic relevance of these factors could facilitate resource allocation and social inclusion.

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Ottosson, Carin. "Somato-psycho-social aspects of recovery after traffic injuries /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-721-9/.

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Macedo, Débora Solange Lopes Macedo. "A psicose – um encontro entre as teorias de Bion e a metodologia Rorschach." Master's thesis, ISPA - Instituto Universitário, 2013. http://hdl.handle.net/10400.12/2793.

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Dissertação de Mestrado em Psicologia Clínica, apresentada ao ISPA - Instituto Universitário
Este estudo tem como ponto de partida a teoria do pensamento e os modelos conceptuais de Bion. A psicose apresenta-se como uma grave perturbação dos processos do pensamento resultantes de falhas que ocorrem durante o desenvolvimento psíquico. Estas implicam défices graves, ou mesmo a ausência das funções consideradas fundamentais para o desenvolvimento do pensamento e da personalidade. Destacamos a função α, a função continente, a função K e a capacidade de rêverie. Acedemos ainda aos conceitos de dimensionalidade psíquica e às noções de vazio, de Grotstein e Meltzer. Neste estudo procuramos compreender, através do Rorschach, os processos característicos da psicose, partindo de algumas hipóteses formuladas com base na conceptualização teórica. Para o efeito foram organizados e adaptados procedimentos de análise Rorschach, em função das hipóteses definidas: falhas na introjeção da função α; falhas na relação continente-conteúdo; inversão da função α; intolerância à frustração; ataque aos vínculos. Os resultados evidenciaram a extrema sensibilidade do instrumento às perturbações dos processos do pensamento, associadas nomeadamente à impossibilidade de pensar e simbolizar, à fragilidade dos limites, à utilização da identificação projetiva patológica, à fuga da realidade, à intolerância ao vazio deixado pela ausência do continente e à bizarria do pensamento.
ABSTRACT: This study has as starting point Bion’s theory of thought and his conceptual models. Psychosis presents itself as a serious disturbance of thought processes resulting from failures that occur during psychic development. These involve serious deficits, or even the absence of functions considered essential for the development of thought and personality. From those, we highlight the α function, the continent function, the K function and the capacity for reverie. We also acceded to Grotstein and Meltzer concepts of psychic dimensionality and emptiness. In this study, we attempt to understand, through Rorschach, the characteristic processes of psychosis, using some hypotheses formulated from the theoretical conceptualization. For this purpose we organized and adjusted some Rorschach analysis procedures, based on the assumptions set: failures in the internalization of the α function; failures in the container-contained relationship; α function in reversal; frustration intolerance, bonds attack. The results showed the extreme sensitivity of the instrument to disturbances of thought processes, particularly related to the inability to think and symbolize the fragility of the boundaries, the use of pathological projective identification, escape from reality, intolerance to the empty space left by the absence of the continent and the bizarreness of thought.

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Helldin, Lars. "The Importance of Remission in the Treatment of Patients with Schizophrenia Spectrum Syndromes : Clinical Long-term Investigation of Psychosis in Sweden." Doctoral thesis, Karlstads universitet, Avdelningen för psykologi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-3738.

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The goal of this thesis was to investigate the hypothesis whether symptomatic remission for patents with schizophrenia spectrum syndrome would provide practical and qualitative benefits for patients and for society. The first work (Paper I) examines the relationship between cross-sectional remission and the patients’ practical resources. The patients’ adaptations to society as well as their employments, living situations and social networks were studied. Their activity of daily living resources are described in terms of the extent to which they could pursue various undertakings autonomously. Their need for care was also studied. The results showed that the patient group that had achieved remission scored better on all of the variables studied, had better resources and less need for medical care and sheltered housing. The second work (Paper II) analysed the relationship between cross-sectional remission and quality of life, burden placed on patients by the illness, and the patients’ satisfaction with care received and with their medication, and also their capacity for understanding their symptoms and their illness. Even the results of this study showed that the patients in the remission group had a better quality of life, bore a lesser burden, were more satisfied with their care and had better insight into their illness. The third work (Paper III) studied the patients’ neurocognitive capacity to see if a higher capacity resulted in a higher percentage of patients achieving remission. The results showed unequivocally that the patients in remission consistently performed better in the cognitive tests. They also showed that they even had a larger vocabulary indicating a higher premorbid capacity. The fourth work (Paper IV) followed the patients over an average time of 65 months. In this study, the patients’ needs for medical care and for housing were investigated. Patients who were not in cross-sectional remission at baseline had for all the measured variables a higher consumption than those in remission even if the differences were not significant, except for patients who lived in sheltered housing and who had greater need for medical care. Taking all these findings together, the result of this thesis shows that the attainment of remission provides practical and qualitative advantages to the patients and to society.

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Grüter, Thomas [Verfasser], Denise [Akademischer Betreuer] Manahan-Vaughan, and Martin [Akademischer Betreuer] Brüne. "Structural and functional alterations in the cortex in a rodent model of first-episode psychosis / Thomas Grüter. Gutachter: Denise Manahan-Vaughan ; Martin Brüne." Bochum : Ruhr-Universität Bochum, 2016. http://d-nb.info/1095884557/34.

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Gregg, Robert. "Functional outcomes of hypoxic brain injury : a systematic review : the influence of childhood trauma and coping on the psychosis phenotype in the general population." Thesis, Queen's University Belfast, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.695346.

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Our understanding of psychotic symptoms can be improved by research exploring schizotypal traits in the general population. Investigating the trauma associated with adverse childhood experiences (ACE), and how these may influence coping resources (locus of control and self-esteem) and maladaptive coping is of interest as previous research indicates these variables may contribute to exacerbation of psychotic-like symptoms in clinical and non-clinical populations. This study used questionnaires posted as a survey on Amazon's Mechanical Turk website to gather information on the foregoing variables from 254 participants. Mediation analyses indicated that an external locus of control mediated the association between ACE and maladaptive coping; that maladaptive coping mediated the relationship between an external locus of control and schizotypal traits; and that maladaptive coping fully mediated the relationship between ACE and schizotypal traits. ACE was not associated with low self-esteem, though maladaptive coping mediated the relationship between low self-esteem and schizotypal traits. The results improve our understanding of the nature of the psychosis spectrum. Implications for future research are discussed.

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Anske, Ute. "Chronopsychobiologische Pilotstudie zur objektiven Bestimmung funktioneller Gesundheitszustände." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2003. http://dx.doi.org/10.18452/14965.

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1. Unterschiedliche Definitionen der Gesundheit mit verschiedenen Betrachtungsweisen (WHO: Der Mensch eine biopsychosoziale Einheit. Schulmedizin: ohne klinischen und paraklinischen Befund mit Orientierung an kritikbedürftigen Referenzmittelwerten) führt bei Fachleuten, Behörden und Laien zu Verwirrungen, wenn es um die Beurteilung gesundheitlicher Schäden geht. 2. Es wurde die Aufgabe gestellt zu prüfen, welche der beiden Definitionen der Realität näher kommt. 3. Mittels der chronopsychobiologischen Regulationsdiagnostik, des Dreiphasenentspannungstests (Hecht und Balzer 2001), wurden unter dem Aspekt der beiden Gesundheitsdefinitionen drei Gruppen untersucht (je 40 Probanden). - klinisch Gesunde (klinisch Gesunde nach Schulmedizin ) - Gesunde nach Definition der WHO - Probanden mit nichtorganische Insomnie (ohne pathologische klinische und paraklinische Befunde) 4. Die mit den verwendeten Methoden gewonnenen Daten wiesen aus, dass zwischen den klinisch Gesunden und den Probanden mit nichtorganischer Insomnie weitgehend größere Ähnlichkeiten bestehen. Beide Gruppen zeigten aber zu der Gruppe der Gesunden nach WHO-Definition, welche die biopsychosoziale Einheit des Menschen berücksichtigt, noch hochsignifikante Unterschiede. Die Gruppe der klinisch Gesunden kann daher auf Grund unserer Ergebnisse nicht den Anspruch erheben, real gesund zu sein. 5. Mit der Bezugnahme auf die Internationale Klassifikation der Krankheiten (ICD 10F) haben die von uns untersuchten klinisch Gesunden und die nichtorganischen Insomniker eine mehr oder weniger stark ausgeprägte Symptomatik von psychischen Störungen. Dies müsste bei der Beurteilung von Schadstoff-, Lärm-, und EMF-Wirkungen auf den Menschen, wie auch bei den klinisch-pharmakoloischen Untersuchungen beachtet werden. Die in der Arbeit erzielten Ergebnisse bedürfen durch weitere Untersuchungen eine Fundierung. Sie signalisieren aber sowohl unter praktischen als auch unter theoretischen Aspekten einen dringenden Forschungsbedarf.
1. Differing definitions of health using different criterea (WHO: The human being as a bio- psycho-social unit versus classical medicine: without clinical and paraclinical results based on suspect reference values) bring confusion to experts, authorities and laymen when assessing health damages. 2. The given task was to check which of the two definitions is closer to reality. 3. Using the chrono-psycho-biological diagnostic of regulation, the three-phase-relaxation test (Hecht and Balzer 2001), three groups were examined considering the aspects of the two health definitions (40 test subjects in the study group). - clinically healthy (clinically healthy per classical medicine definition) - healthy per definition of the WHO - test persons with non organic insomnia (i.e. no pathological or paraclinical findings) 4. The data gained from the employed methods revealed bigger similarities between clinically healthy persons and those with non organic insomnia. Both groups still showed highly significant differences to the group which fulfils the definition of the WHO regarding a human as a bio-psycho-social unit. As a result of this study, persons, though classified as "clinically healthy" might nevertheless not absolutely be healthy in reality. 5. In reference to the international classification of illnesses (ICD 10 F) the groups examined, both of clinically healthy and those with non organic insomnia, have more or less severe psychological symptoms. This should be taken into account when assessing the effects of pollution, noise, and EMF as well as clinical pharmacological studies. These present findings still need broader confirmation by further investigations. However, they clearly indicate, for practical and theoretical considerations, an urgent need for further research.

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Jukuri, T. (Tuomas). "Resting state brain networks in young people with familial risk for psychosis." Doctoral thesis, Oulun yliopisto, 2016. http://urn.fi/urn:isbn:9789526211107.

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Abstract Neuropsychiatric illnesses usually become overtly manifest in adolescence and early adulthood. A critical long-term aim is to be able to prevent the development of such illnesses, which requires instruments to identify subjects at high risk of illness and to offer them effective interventions. There is an indisputable need for more sophisticated methods to enable more precise detection of adolescents and young adults who are at high risk of developing psychosis. Abnormal function in brain networks has been reported in people with schizophrenia and other psychotic disorders. Similar abnormalities have been found also in people at risk for developing psychosis, but it is not known whether this applies also to spontaneous resting state activity in young people with a familial risk for psychosis. We conducted resting-state functional MRI (R-fMRI) in 72 (29 male) young adults with a history of psychosis in one or both parents (FR) but without psychosis themselves, and 72 (29 male) similarly healthy control subjects without familial risk for psychosis. Both groups in the Oulu Brain and Mind study were drawn from the Northern Finland Birth Cohort 1986. All volunteers were 20–25 years old. Parental psychosis was established using the Care Register for Health Care. R-fMRI data was pre-processed using independent component analysis (ICA). A dual regression technique was used to detect between-group differences with p < 0.05 threshold corrected for multiple comparisons at voxel level. FR subjects demonstrated significantly decreased activity compared to control subjects in the default mode network and in the central executive network and increased activity in the cerebellum. The findings clarify previously controversial literature on the subject. The finding suggests that abnormal activity in these brain networks in rest may be associated with increased vulnerability to psychosis. The findings maybe helpful in developing more precise methods for detecting young people at highest risk for developing psychosis
Tiivistelmä Psykoottisiin häiriöihin sairastutaan yleensä nuoruudessa tai varhaisaikuisuudessa. Psykoositutkimuksen tavoitteena on löytää uusia menetelmiä, joiden avulla kyettäisiin tunnistamaan suurimmassa psykoosiriskissä olevat nuoret, jotta heille voitaisiin tarjota sairautta ennaltaehkäiseviä hoitokeinoja. Skitsofreniaan ja muihin psykoottisiin häiriöihin sairastuneilla on havaittu aivotoiminnan poikkeavuuksia. Samankaltaisia aivotoiminnan poikkeavuuksia on havaittu myös nuorilla, jotka ovat vaarassa sairastua psykoosiin. Toistaiseksi on ollut epäselvää, onko psykoosiin sairastuneiden henkilöiden lapsilla aivohermoverkkojen toiminnan poikkeavuuksia lepotilassa. Suoritimme aivojen lepotilan MRI-tutkimuksen (R-fMRI) 72:lle (29 miestä) nuorelle aikuiselle, joiden jompikumpi vanhempi oli sairastunut psykoosin sekä 72:lle (29 miestä) nuorelle aikuiselle, joiden vanhemmat eivät olleet sairastaneet psykoosia. Molemmat tutkimusryhmät tässä Oulu Brain and Mind -tutkimuksessa olivat Pohjois-Suomen 1986 syntymäkohortin jäseniä. Tutkittavat olivat 20–25 vuoden iässä. Lepotilan toiminnallinen magneettikuvaus suoritettiin 1.5 Teslan Siemensin magneettikuvantamislaitteella. Tutkimuskohteiksi valittiin lepotilan toiminnallinen aivohermoverkko, toiminnan ohjauksesta vastaava aivohermoverkko ja pikkuaivot. Kuvantamisdataan sovellettiin itsenäisten komponenttien analyysia aivohermoverkkojen määrittämistä varten. Ryhmien välisen eron havaitsemiseen käytettiin ei-parametristä permutaatiotestiä, joka kynnystettiin tilastollisesti merkitsevään tasoon (p < 0.05). Lepotilan oletushermoverkossa ja toiminnanohjauksesta vastaavassa aivohermoverkoissa havaittiin vähäisempää aktiivisuutta ja pikkuaivoissa kohonnutta aktiivisuutta perinnöllisessä psykoosiriskissä olevilla nuorilla aikuisilla verrattuna verrokkeihin. Tutkimustulokset selkeyttivät aiempaa ristiriitaista kirjallisuutta tutkimusaiheesta. Tutkimuksessa havaittujen aivoalueiden poikkeava toiminta lepotilassa voi liittyä kohonneeseen psykoosin puhkeamisriskiin. Tutkimuslöydösten avulla voidaan todennäköisesti edesauttaa parempien kuvantamismenetelmien kehittämistä suurimmassa psykoosiriskissä olevien nuorten tunnistamiseen

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Goldberg, Ximena. "Complex Models of Genetic and Environmental Influences on Human Cognition. Implications for Functional Psychoses / Modelos complejos de las influencias genéticas y ambientales en la cognición humana. Implicaciones para las psicosis funcionales." Doctoral thesis, Universitat de Barcelona, 2012. http://hdl.handle.net/10803/83588.

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The general construct of human cognition implies a series of mental processes by means of which human interpret and consequently act on the world that surrounds them (Sternberg y Mio, 2009). During the last decades, the recognition of human diversity and psychological variability among individuals has encouraged challenging questions addressing inter-individual differences that make each subject unique in terms of their cognitive performance (Baddeley, 2003; Botvinick, 2008). In particular, quantitative genetic studies show that both genetic variability and environmental factors are involved in the phenotypic expression of cognitive functions (Plomin, 2011). However, the mechanisms by which genes and exposure to environmental influences may contribute to the observed variability are not yet clear. The study of the origins of inter-individual differences in cognition is strongly associated with the ontogenic development of the human brain (Tau, 2010). As a consequence, cognitive alterations are considered a central trait in those mental disorders where neurodevelopmental alterations are assumed to exist, such as schizophrenia. This disease, which affects around 1% of the world’s population, is one of the main causes of years lost due to disability (WHO, 2004), while cognitive alterations in these patients explain about 20%-60% of the variance in measures of outcome (Green, 2004). The aetiological model of neurodevelopment in schizophrenia proposes that this disease might be the expression of neurobiological compromise that could begin early in the lifespan, even before the onset of the clinical symptoms (van Os, 2009). However, and despite the scientific efforts invested in the elucidation of its aetiological underpinnings, the heterogeneous presentation of the disease has prevented a deeper comprehension of these mechanisms. Are all cognitive domains heritable? Are there long-term consequences on cognition for the early exposure to environmental impact? What is the association between genetic variability and cognitive vulnerability? Can we identify specific neurobiological pathways in the expression of the cognitive alterations of patients with schizophrenia? These questions are explored in the present thesis through the analyses of twins- and family-based samples, which constitute powerful designs to study the effects of genetic and environmental variability on human cognition. In the six chapters of results that are the body of this thesis, complex models are proposed that aim at representing the mechanisms involved in the origin of cognitive variability at the population level. The findings included indicate that this variability could be the result of the relative contribution of genetic determination and environmental modelling, which could vary in different cognitive functions following ontogenic mechanisms of neurodevelopment. Specifically, results are reported on the influences of childhood maltreatment and socioeconomic status as environmental stressors, as well as Val158Met functional polymorphism of COMT gene as a genetic factor. The aetiological implications of the study of these processes are extended to the field of mental disorders, as the results may indicate that the cognitive variability present among patients with schizophrenia could support a model of developmental compromise in this disease. Accordingly, the effects of genetic and environmental influences on behaviour may underlie the heterogeneous expression of this highly disabling mental disorder. To sum up, the phenotypic diversity of schizophrenia and human cognition, far from representing an obstacle, lays the foundations for complex models of these traits that may feed an increasing understanding of their aetiology (Belsky, 2011). These findings highlight the putative role of neurobiological liability traits in crucial aspects of clinical practice. Risk factors might be identified that could be included as potential guidelines in the assessment and management of need-adapted treatments (Leiftker, 2009). Moreover, liability traits might operate as markers in preventive interventions for targeting individuals at risk of developing particular forms of the disease (Keshavan, 2011).
El constructo general de cognición humana involucra una serie de procesos mentales por medio de los cuales los individuos perciben, interpretan y, en consecuencia, actúan sobre la realidad que los rodea y sobre sus pares (Sternberg y Mio, 2009). En los últimos años, el reconocimiento de la diversidad humana y la variabilidad de los rasgos psicológicos entre los individuos ha promovido preguntas acerca de las diferencias inter-individuales que hacen a cada sujeto único en términos de cognición (Baddeley, 2003; Botvinick, 2008). En particular, los estudios de genética cuantitativa demuestran que tanto la variabilidad genética como los factores ambientales podrían estar involucrados en la expresión fenotípica de las funciones cognitivas (Plomin, 2011). Sin embargo, aún no son claros los mecanismos específicos por medio de los cuales los genes y el ambiente contribuyen a esta variabilidad. Las alteraciones cognitivas son un rasgo central en enfermedades mentales donde se presume que existen alteraciones del neurodesarrollo, como lo es la esquizofrenia. El modelo etiológico del neurodesarrollo de la esquizofrenia propone que esta enfermedad se expresaría como consecuencia de alteraciones neurobiológicas que iniciarían en una época temprana de la vida, incluso antes del desencadenamiento de los síntomas clínicos (van Os, 2009). No obstante, la presentación heterogénea de la enfermedad ha dificultado una comprensión más clara de los mecanismos involucrados en su manifestación. ¿Son todas las funciones cognitivas igualmente heredables? ¿Tienen los factores ambientales tempranos consecuencias a largo plazo sobre la cognición? ¿Cuál es la relación entre variabilidad genética y vulnerabilidad cognitiva? ¿Existen vías neurobiológicas específicas para la manifestación de las alteraciones cognitivas en pacientes con esquizofrenia? Estas preguntas se exploran en la presente tesis a partir de análisis basados en muestras de gemelos y en grupos familiares, que constituyen una manera metodológicamente potente de estudiar los efectos de la variabilidad genética y ambiental sobre la cognición humana. En este sentido, la diversidad fenotípica de la esquizofrenia y la cognición humana, lejos de representar un obstáculo para la investigación de su etiología, sienta las bases de modelos complejos que podrían fomentar una comprensión cada vez más completa de los mecanismos de vulnerabilidad y resiliencia posiblemente involucrados en su origen (Belsky, 2011).

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44

Bodén, Robert. "Prognostic Factors in First-Episode Schizophrenia : Five-year Outcome of Symptoms, Function and Obesity." Doctoral thesis, Uppsala universitet, Psykiatri, Ulleråker, Akademiska sjukhuset, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-113797.

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Our knowledge of prognostic factors and optimal treatment organisation in schizophrenia is incomplete. The disparity of outcome measures used has been a major obstacle for research. Increasing evidence has shown that schizophrenia is associated with increased cardiovascular mortality, development of obesity and autonomic nervous system imbalance. Assertive community treatment (ACT) has been suggested as a promising direction for organising treatment services for first-episode schizophrenia, but its long-term effect has not been evaluated. One aim of the present thesis was to investigate prognostic factors for 5-year symptomatic and functional outcome and obesity development. A further aim was to evaluate a recently proposed definition of remission and examine the long-term effects of introducing a modified ACT programme (mACT). Thus, we performed a follow-up study of all consecutive first-episode psychosis patients in Uppsala County, Sweden during 1995-2000 (n=144). In the first study we investigated the changes in a broad 5-year outcome of symptoms and function among patients presenting first time ever to psychiatric health care during 3 years before and during 3 years after the implementation of mACT. This change in the psychiatric service, however, was not followed by any long-term clinical benefits. In the second study, we examined the association between remission of eight core schizophrenia symptoms and functional outcome. Remission was strongly associated with having good function and having a higher self-rated satisfaction with life. In the third study, we explored a set of biochemical markers as predictors of weight gain and development of obesity. Haemoglobin, red blood cell count, hematocrit, γ-glutamyltransferase and creatinine were associated with the development of obesity in first-episode schizophrenia. In the fourth and final study, we tested electrocardiographic measures of autonomic imbalance as predictors of symptomatic remission. Higher heart rate and high ST and T-wave amplitudes were related to symptomatic remission, indicating that cardiac autonomic imbalance at baseline may have a prognostic value in first-episode schizophrenia.

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45

Roman, Urrestarazu Andrés Ernesto. "Brain structure and working memory function in the Psychosis Risk Study and the Adult ADHD Study of the 1986 Northern Finland Birth Cohort." Thesis, University of Cambridge, 2014. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708009.

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46

Tourte, Alain. "Quel traitement pour le sujet autiste ? : exposé et analyse critique des principales approches de l'autisme : les différents moyens mis en oeuvre par le sujet autiste pour compenser sa carence symbolique : développement d'un traitement possible du sujet autiste." Thesis, Strasbourg, 2012. http://www.theses.fr/2012STRAG046.

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Ce travail soutient une conception non déficitaire de l’autisme. Il s’intéresse au traitement du sujet autiste, à son accompagnement et son évolution subjective. Il développe une prise en charge des autistes centrée sur leur fonctionnement spécifique et leur singularité. Il fait l’hypothèse d’un sujet au travail dans l’autisme, qui cherche désespérément à réfréner ce qui l’envahit, à tempérer son angoisse, et à symboliser son monde. Notre lecture lacanienne des principales approches de l’autisme (psychodynamiques, comportementales, cognitives) permet de dégager les conditions et modalités de traitement qui favorisent la relance du sujet autiste dans la dynamique du langage, son ouverture à autrui, à la connaissance, et au lien social. Cette évolution passe par l’élaboration d’un « symptôme autistique ». Nous montrons la fonction thérapeutique essentielle des différents moyens de compensation (ou « bases de suppléances ») à la carence symbolique, mis en oeuvre par le sujet autiste. Et précisons la fonction et le rôle déterminant du thérapeute au cours du traitement. Enfin, nous dégageons une clinique différentielle entre autisme et psychose
This work supports an approach of autism as non deficient. It focuses on treatment, support and subjective evolution of the autistic subject. It develops a care centered on specificity and singularity of this subject. It makes the hypothesis that there is a subject working his way through in autism, desperately trying to stop what invades him, to moderate his anxiety, to symbolize his world. Our lacanian reading of the major approaches to autism (psychoanalytical, behaviorism, cognitivism) allows to develop the conditions and methods of a treatment that helps the autistic subject to re-start in the dynamics of language, stimulates his opening in others, in knowledge, and in social links. This evolution requires the elaboration of an « autistic symptom ». We underline the essential therapeutic function of various means of compensation (or « suppletion basis ») for the symbolic deficiency used by the autistic subject. And we specify the function and determining role of the therapist during the treatment. Finally, we define a differential clinical approach between autism and psychosis

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47

Saleem, Majid Mohammed. "Investigation into cognitive function in first episode psychosis and chronic schizophrenia patients : an investigation into cognitive deficits associated with first episode psychosis and chronic schizophrenia patients in South Asian and Caucasian populations as assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB)." Thesis, University of Bradford, 2012. http://hdl.handle.net/10454/5689.

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Rationale Cognitive deficits are now recognised as a major symptom of schizophrenia with a number of studies reporting profound deficits in cognitive function in both chronic and first episode patients. Recent advances in cognitive remediation therapy have provided the opportunity for patients to improve their cognitive function and therefore improve their functional outcome. Aim The aim of the present study was to investigate cognitive deficits using the Cambridge Neuropsychological Test Automated Battery (CANTAB®) in first episode psychosis and chronic schizophrenia patients. In the first episode population the effect of ethnicity on cognition was also examined. In the chronic schizophrenia study comparisons between severity of deficits with first episode psychosis patients were also made. The effects of cognitive remediation therapy were also examined in a sample of first episode patients. Methods A total of 35 patients and 30 healthy controls were recruited into the first episode study, 17 patients and 17 controls into the chronic schizophrenia study and 11 patients into the cognitive remediation study. The first episode psychosis patients were recruited from the Bradford and Airedale Early Intervention Service and the chronic patients from the Leeds Partnership NHS Foundation Trust. The control subjects were matched as closely as possible in terms of intelligence and demographics to the patient groups. The Wechsler Test of Adult Reading (WTAR) was used to estimate subjects pre-morbid IQ. The severity of symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS). All subjects who took part in the study completed a comprehensive battery of neuropsychological tests from the CANTAB®. Patients in the cognitive remediation study participated in group therapy sessions using X-cog®. Results There were no significant differences found between There were no significant differences found between patients and controls in relation to intelligence or demographics in all studies. The effect of ethnicity was shown to be not significant in the first episode study. Results show that patients performed significantly worse than controls across all iv cognitive domains tested in all studies. A correlation between negative symptoms and executive function was found in both first episode and chronic schizophrenia patients. Comparisons between first episode psychosis and chronic schizophrenia patients in cognition showed no significant differences, however significant differences were found in levels of negative symptoms and age between the two groups with chronic patients scoring higher on negative symptoms and being older. In the cognitive remediation study a significant improvement was observed in patients in the domain of executive function and a reduction in negative symptoms following completion of the intervention. Conclusion First episode and chronic schizophrenia patients display significant cognitive deficits across all domains when tested using the CANTAB®. Some of these deficits appear to be independent of the length of the illness but dependent on negative symptoms. This study demonstrates that cognitive deficits exist across all patient groups regardless of age, gender, pre-morbid IQ, years in education and ethnicity. Cognitive remediation therapy has also been shown to be effective in improving cognitive functioning in patients.

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48

Saleem, Majid M. "Investigation into cognitive function in first episode psychosis and chronic schizophrenia patients. An investigation into cognitive deficits associated with first episode psychosis and chronic schizophrenia patients in South Asian and Caucasian populations as assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB)." Thesis, University of Bradford, 2012. http://hdl.handle.net/10454/5689.

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Rationale Cognitive deficits are now recognised as a major symptom of schizophrenia with a number of studies reporting profound deficits in cognitive function in both chronic and first episode patients. Recent advances in cognitive remediation therapy have provided the opportunity for patients to improve their cognitive function and therefore improve their functional outcome. Aim The aim of the present study was to investigate cognitive deficits using the Cambridge Neuropsychological Test Automated Battery (CANTAB®) in first episode psychosis and chronic schizophrenia patients. In the first episode population the effect of ethnicity on cognition was also examined. In the chronic schizophrenia study comparisons between severity of deficits with first episode psychosis patients were also made. The effects of cognitive remediation therapy were also examined in a sample of first episode patients. Methods A total of 35 patients and 30 healthy controls were recruited into the first episode study, 17 patients and 17 controls into the chronic schizophrenia study and 11 patients into the cognitive remediation study. The first episode psychosis patients were recruited from the Bradford and Airedale Early Intervention Service and the chronic patients from the Leeds Partnership NHS Foundation Trust. The control subjects were matched as closely as possible in terms of intelligence and demographics to the patient groups. The Wechsler Test of Adult Reading (WTAR) was used to estimate subjects pre-morbid IQ. The severity of symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS). All subjects who took part in the study completed a comprehensive battery of neuropsychological tests from the CANTAB®. Patients in the cognitive remediation study participated in group therapy sessions using X-cog®. Results There were no significant differences found between There were no significant differences found between patients and controls in relation to intelligence or demographics in all studies. The effect of ethnicity was shown to be not significant in the first episode study. Results show that patients performed significantly worse than controls across all iv cognitive domains tested in all studies. A correlation between negative symptoms and executive function was found in both first episode and chronic schizophrenia patients. Comparisons between first episode psychosis and chronic schizophrenia patients in cognition showed no significant differences, however significant differences were found in levels of negative symptoms and age between the two groups with chronic patients scoring higher on negative symptoms and being older. In the cognitive remediation study a significant improvement was observed in patients in the domain of executive function and a reduction in negative symptoms following completion of the intervention. Conclusion First episode and chronic schizophrenia patients display significant cognitive deficits across all domains when tested using the CANTAB®. Some of these deficits appear to be independent of the length of the illness but dependent on negative symptoms. This study demonstrates that cognitive deficits exist across all patient groups regardless of age, gender, pre-morbid IQ, years in education and ethnicity. Cognitive remediation therapy has also been shown to be effective in improving cognitive functioning in patients.

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49

Rodrigue, Mary. "Assessing the Psychosocial Needs of Individuals Diagnosed with Cancer, by Age and Sex on Interest in Support Group Attendance." ScholarWorks@UNO, 2010. http://scholarworks.uno.edu/td/1276.

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There are several psychosocial factors that can affect an individual diagnosed with cancer (Holland, 2003), and directly addressing these issues with patients is important for their overall care and quality of life (Holland, 1998). The practice of psycho-oncology has been designed to assess these psychosocial issues with patients and their caregivers by means of outlets such as support groups to facilitate a wellness model of care (Myers & Sweeney, 2008). Using the demographics of age and sex, I plan to analyze and identify what psychosocial needs are significant to individuals diagnosed with cancer, and compare the sex and age of two significantly represented patient age groups 18-40 and 41-80 years old. I will survey the patients of Tulane Cancer Center in New Orleans, Louisiana when they arrive for medical treatment at the facility. The survey will include a demographic page, the Functional Assessment of Cancer Therapy-General (FACT-G (Version 4), the Body Image Scale (BIS), the Changes in Sexual Functioning Questionnaire-Short Form (CSFQ-14), and additional questions regarding the extent to which an individual would attend a support group designed for their specific age and sex demographic. Through data analysis, I hope to discover whether any of the variables of body image, sexual functioning, physical well being, social/family well being, emotional well being, and functional well being show significant differences between the male or female young adult population of 18-40 year olds and those patients who are 41-80 years old. The findings should allow psycho-oncology clinicians to utilize this knowledge to address what psychosocial needs are appropriate for each age and sex group, and thus enhance the overall care of the patient.

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50

Stålberg, Gabriella. "Vulnerability and Social Functioning in Schizophrenia." Doctoral thesis, Uppsala universitet, Psykiatri, Akademiska sjukhuset, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-209626.

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This thesis offers a broad approach in elucidating biological risk factors, as well as psychological and social functioning in schizophrenia. The aims are as follows: (I) investigate the association between birth characteristics and schizophrenia, (II) study the association between levels of neurotransmitter neuropeptide Y (NPY) in cerebrospinal fluid (CSF), social function and longitudinal outcome in schizophrenia, (III) compare social functioning of patients with schizophrenia with their biological siblings and (IV) explore how siblings to patients with schizophrenia perceive the sibling relationship and their role. Paper I was a cohort analysis of 11,360 same-sexed twins in which obstetric records were used. Low birth weight and small head circumference were associated with later development of schizophrenia. To some extent the results persisted in the within-pair analyses conducted on 82 pairs discordant for schizophrenia. Fifty-six patients with schizophrenia were included in paper II. Levels of NPY in CSF correlated to social competence at index admission. For each standard deviation increase in baseline NPY, there was a concomitant increased risk of being unemployed, having moderate or severe symptoms or recent hospitalization at the 3-year follow-up. In paper III, social functioning was investigated using the Swedish version of the videotaped test Assessment of Interpersonal Problem Solving Skills (AIPSS) in 70 participants (25 patients with schizophrenia, 20 siblings and 25 randomly selected controls). The patients presented severe deficits in social functioning. The siblings expressed subtle impairments in nonverbal language but did not generally differ from the controls. To explore the siblings’ perspective on schizophrenia a qualitative study was conducted with interviews of 16 siblings in paper IV. A unifying major theme was an emotional sibling bond. Siblings developed several coping patterns, including avoidance, isolation, normalization, care giving and grieving. A third major theme consisted of the fear of inheriting schizophrenia. In conclusion, fetal growth, altered levels of NPY in CSF and subtle impairments in nonverbal social behavior might be important risk factors in schizophrenia. Patients with schizophrenia revealed extensive impaired social functioning, and from the siblings’ perspective, a brother or sister’s diagnosis of schizophrenia seems to have a profound psychological impact on the siblings.

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