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1.
Schizophr Bull ; 50(5): 1117-1126, 2024 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-38300759

RESUMO

BACKGROUND AND HYPOTHESIS: Based on a childhood intervention from ages 3 to 5 years that included additional fish consumption and which resulted in reduced schizotypal personality at age 23, we had previously hypothesized that omega-3 could reduce schizotypy. The current study tests the hypothesis that omega-3 supplementation reduces schizotypy in children. STUDY DESIGN: In this intention-to-treat, randomized, single-blind, stratified, factorial trial, a community sample of 290 children aged 11-12 years were randomized into Omega-3 Only, Cognitive Behavioral Therapy (CBT) Only, Omega-3 + CBT, and Control groups. Schizotypy was assessed using the SPQ-C (Schizotypal Personality Questionnaire for Children) at 0 months (baseline), 3 months (end of treatment), 6 months (3 months post-treatment), and 12 months (9 months post-treatment). STUDY RESULTS: A significant group × time interaction (P = .013) indicated that, compared with Controls, total schizotypy scores were reduced in both Omega-3 Only and Omega-3 + CBT groups immediately post-treatment (d = 0.56 and 0.47, respectively), and also 3 months after supplementation terminated (d = 0.49, d = 0.70). Stronger findings were observed for the interpersonal schizotypy factor, with both omega-3 groups showing reductions 9 months post-treatment compared with the CBT Only group. Schizotypy reductions were significantly stronger for those with higher dietary intake of omega-3 at intake. Sensitivity analyses confirmed findings. CONCLUSIONS: Results are unique in the field and suggest that omega-3 can help reduce schizotypal personality in community-residing children. From an epidemiological standpoint, if replicated and extended, these findings could have implications for early prevention of more significant schizotypal features developing later in adolescence. CLINICAL TRIAL REGISTRATION: "Healthy Brains & Behavior: Understanding and Treating Youth Aggression (HBB)." ClinicalTrials.gov Identifier: NCT00842439, https://clinicaltrials.gov/ct2/show/NCT00842439.


Assuntos
Terapia Cognitivo-Comportamental , Suplementos Nutricionais , Ácidos Graxos Ômega-3 , Transtorno da Personalidade Esquizotípica , Humanos , Transtorno da Personalidade Esquizotípica/terapia , Masculino , Criança , Feminino , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-3/farmacologia , Método Simples-Cego , Terapia Cognitivo-Comportamental/métodos , Terapia Combinada , Avaliação de Resultados em Cuidados de Saúde
2.
BMJ Open ; 13(11): e075140, 2023 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-37977859

RESUMO

INTRODUCTION: Schizotypal disorder is associated with a high level of disability at an individual level and high societal costs. However, clinical recommendations for the treatment of schizotypal disorder are scarce and based on limited evidence. This review aims to synthesise the current evidence on treatment for schizotypal disorder making recommendations for clinical practice. METHODS AND ANALYSIS: This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search will be performed in PsychArticles, Embase, Medline and Cochrane Central Register of Controlled Trials. Additionally, we will search for relevant articles manually. Inclusion criteria are published studies including individuals diagnosed with schizotypal personality disorder according to Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, or schizotypal disorder according to International Classification of Diseases (ICD) criteria. We will include interventional studies comprising any pharmacological and non-pharmacological treatment trials for patients with schizotypal disorder, and all relevant outcome measures will be reported. Risk of bias will be assessed by Cochrane risk-of-bias tools. Data will be synthesised using narrative or thematic analysis and, if suitable, through meta-analysis. ETHICS AND DISSEMINATION: No original data will be collected as part of this study and ethics approval is, therefore, not applicable. The results will be disseminated through peer-reviewed publication and presented at international scientific meetings. We will aim at submitting the final paper for publication within 4 months of completion of analyses. Furthermore, this systematic review will inform clinicians and researchers on the current state of evidence on treatment for schizotypal disorder. Findings may guide proposals for further research and potentially guide recommendations for clinical practice using the Grading of Recommendations Assessment, Development and Evaluation. PROSPERO REGISTRATION NUMBER: CRD42022375001.


Assuntos
Transtorno da Personalidade Esquizotípica , Humanos , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/terapia , Revisões Sistemáticas como Assunto , Projetos de Pesquisa , Metanálise como Assunto , Literatura de Revisão como Assunto
3.
Clin Psychol Psychother ; 30(6): 1264-1278, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37675964

RESUMO

BACKGROUND: Treatment of schizotypal personality disorder is complex. Currently, there are no clear evidence-based recommendations for use of psychotherapy for individuals suffering from this mental illness, and studies are sparse. Our aim in this review is to map and describe the existing research and to answer the research question: What do we know about the use of psychotherapy for people with schizotypal personality disorder? METHODS: We conducted a scoping review using systematic searches in the Embase, MEDLINE and PsycINFO databases. Two reviewers screened possible studies and extracted data on subject samples, type of psychotherapy, outcomes and suggested mechanisms of change. The review is based on the PRISMA checklist for scoping reviews. RESULTS: Twenty-three papers were included, and we found a wide variety of study types, psychotherapeutic orientations and outcomes. Few studies emerged that focused solely on schizotypal personality disorder. CONCLUSION: Psychotherapy as a treatment for schizotypal personality disorder is understudied compared with diagnoses such as schizophrenia and borderline personality disorder. Our results included two randomized controlled studies, as well as mainly smaller studies with different approaches to diagnostic criteria, psychotherapeutic orientation and outcome measures. The findings are too sparse and too diverse to make any evidence-based recommendations. We found some indications that psychotherapy may support and assist individuals with schizotypal personality disorder.


Assuntos
Transtorno da Personalidade Borderline , Esquizofrenia , Transtorno da Personalidade Esquizotípica , Humanos , Transtorno da Personalidade Esquizotípica/terapia , Transtorno da Personalidade Esquizotípica/diagnóstico , Psicoterapia/métodos , Transtorno da Personalidade Borderline/terapia , Avaliação de Resultados em Cuidados de Saúde
4.
BMC Psychiatry ; 23(1): 113, 2023 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-36803673

RESUMO

BACKGROUND: Schizotypal personality disorder is characterized by a pervasive pattern of maladaptive behavior that has been associated with the liability for schizophrenia. Little is known about effective psychosocial interventions. This pilot non-inferiority randomized controlled trial aimed to compare a novel form of psychotherapy tailored for this disorder and a combination of cognitive therapy and psychopharmacological treatment. The former treatment - namely, Evolutionary Systems Therapy for Schizotypy-integrated evolutionary, metacognitively oriented, and compassion focused approaches. METHODS: Thirty-three participants were assessed for eligibility, twenty-four randomized on a 1:1 ratio, nineteen included in the final analysis. The treatments lasted 6 months (24 sessions). The primary outcome was change across nine measurements in personality pathology, the secondary outcomes were remission from diagnosis and pre-post changes in general symptomatology and metacognition. RESULTS: Primary outcome suggested a non-inferiority of the experimental treatment in respect to control condition. Secondary outcomes reported mixed results. There was no significant difference in terms of remission, but experimental treatment showed a larger reduction of general symptomatology (η2 = 0.558) and a larger increase in metacognition (η2 = 0.734). CONCLUSIONS: This pilot study reported promising results about the effectiveness of the proposed novel approach. A confirmatory trial on large sample size is needed to provide evidence about relative effectiveness of the two treatment conditions. TRIAL REGISTRATION: ClinicalTrials.gov; NCT04764708; Registration day 21/02/2021.


Assuntos
Terapia Cognitivo-Comportamental , Metacognição , Transtorno da Personalidade Esquizotípica , Humanos , Transtorno da Personalidade Esquizotípica/terapia , Transtorno da Personalidade Esquizotípica/psicologia , Projetos Piloto , Empatia , Terapia Cognitivo-Comportamental/métodos
5.
J Clin Psychol ; 77(8): 1798-1806, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34416012

RESUMO

INTRODUCTION: Difficulties forming an integrated sense of oneself, others, and one's place in the community have been observed to pose a barrier to recovery from schizophrenia spectrum disorders (SSD). This has promoted the development of metacognitive approaches to psychotherapy that seek to assist persons in making sense of and managing their psychosocial challenges. One of these approaches, Metacognitive Reflection Insight Therapy (MERIT), has begun to be more broadly explored among adults with schizophrenia. Persons with other forms of SSD, including schizotypal personality disorder (SPD), also experience difficulties forming an integrated sense of themselves and others and could potentially be amenable to MERIT. METHODS: To explore this possibility, this study reports the application of MERIT to an adult with SPD in a unique cultural context. RESULTS: Evidence of acceptability and meaningful resultant clinical gains are described. CONCLUSIONS: Taken as a whole, this study provides a rich illustration of how metacognition can be successfully targeted by MERIT in forms of SSD potentially less severe than schizophrenia, including SPD in a unique cultural setting.


Assuntos
Metacognição , Terapia Psicanalítica , Transtorno da Personalidade Esquizotípica/psicologia , Transtorno da Personalidade Esquizotípica/terapia , Humanos , Masculino , Esquizofrenia/terapia , Adulto Jovem
6.
Early Interv Psychiatry ; 15(5): 1433-1436, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33242926

RESUMO

BACKGROUND: Delays in help-seeking for anxiety are common; however, earlier interventions improve long-term outcomes. This holds importance for high schizotypes since anxiety relates to psychotic symptom development. The study investigated whether schizotypal traits and anxiety itself influence help-seeking behaviour. METHODS: A non-clinical student sample (N = 800) completed the Schizotypal Personality Questionnaire, Depression, Anxiety, Stress Scale and General Help-Seeking Questionnaire, vignette version online. RESULTS: Recognizing another's help need was associated with lower anxiety scores. A trend was observed between lower schizotypy scores and better recognition of self-need for help. Actual help-seekers (N = 163) had significantly higher schizotypy and anxiety scores than non-help-seekers. CONCLUSION: Schizotypal traits independently contribute to delays in help-seeking for anxiety. Approaching informal help sources whom also have anxiety symptoms can delay formal help-seeking, unless they have sought help themselves.


Assuntos
Transtornos Psicóticos , Transtorno da Personalidade Esquizotípica , Ansiedade/terapia , Transtornos de Ansiedade , Humanos , Personalidade , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/terapia , Inquéritos e Questionários
7.
Psychiatr Danub ; 32(Suppl 1): 194-199, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890389

RESUMO

G.B., 21-year-old patient of Albanian origin suffering from acute psychotic burning on schizotypal personality disorder induced by substance abuse, was admitted to the Psychiatric Service at Perugia' General Hospital, Italy. On admission, antipsychotic therapy was set up which had the role to reduced delusional and hallucinatory symptoms but the suspiciousness, the presence of magical thought and the closure towards surrounding world that characterize it, combined with the presence of intrusive images, consequently increased the anxiety experiences and negatively affects the establishment of a therapeutic relationship with the operators. During the hospitalization, daily support interviews were carried out: G.B. showed clear difficulty in expressing his own thought contents in presence of more than two operators emerged jointly with the tendency to project different emotional experiences based on the gender of the operator. Following these observations, with the aim to carrying out an intervention that could integrate a psychological approach to the pharmacological therapy in place, a specific personalized support setting was set up, consisting of a female and a male operator. This setting was structured coherently with the therapeutic goals to be achieved: creation of a therapeutic alliance, the integration of the patient's emotional experiences and containing the splitting through the transference analysis. By means of this setting, the patient has obtained a substantial improvement of the splitting framework allowing a better integration of his emotional experiences. At the end of the sessions, G.B. showed more confidence with the medical staff and showed himself to be more aware of his pathological and non-pathological mental states and consequently more adherent to taking drug therapy and to the continuation of post-discharge psychological therapy.


Assuntos
Transtorno da Personalidade Esquizotípica , Assistência ao Convalescente , Feminino , Humanos , Pacientes Internados , Itália , Masculino , Alta do Paciente , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/terapia , Adulto Jovem
8.
Schizophr Res ; 215: 399-407, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31471248

RESUMO

This study investigated the efficacy of 10-module metacognitive training (MCT) among Japanese patients with schizophrenia by conducting a multicenter randomized controlled trial to test the influence of the most recent and extended version of MCT on positive symptoms. A six-center, randomized, assessor-blind, controlled trial between "treatment as usual" (TAU) and TAU + MCT was conducted. Fifty inpatients and outpatients with schizophrenia, schizotypal, and delusional disorders (ICD 10) were enrolled, then randomly assigned to TAU (n = 26) or TAU + MCT (n = 24). Assessments were made at baseline, after six weeks, immediately posttreatment, and 1-month post-treatment. The primary outcome was positive symptom score, as measured by the Positive and Negative Syndrome Scale (PANSS). General assessment of functioning (GAF) and measures of cognitive biases were secondary outcomes. Completion at post-treatment (10 weeks later) and 1-month follow-up was high-TAU + MCT, n = 22 (91.67%) and TAU, n = 23 (88.46%). The severity of PANSS positive symptoms declined significantly in the TAU + MCT treatment group compared with the TAU group. GAF also showed significantly greater improvement in the TAU + MCT group compared with the TAU group. There was also a trend for greater efficacy of MCT on cognitive biases. In conclusion, this study provides support for the efficacy of 10 module MCT concerning positive symptomatology (especially, delusion) and general functioning.


Assuntos
Remediação Cognitiva/métodos , Metacognição , Avaliação de Resultados em Cuidados de Saúde , Transtornos Psicóticos/terapia , Esquizofrenia/terapia , Transtorno da Personalidade Esquizotípica/terapia , Pensamento , Adulto , Feminino , Humanos , Japão , Masculino , Metacognição/fisiologia , Pessoa de Meia-Idade , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/fisiopatologia , Transtorno da Personalidade Esquizotípica/fisiopatologia , Método Simples-Cego , Pensamento/fisiologia
9.
Personal Ment Health ; 13(3): 155-167, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31169366

RESUMO

Schizotypal personality disorder represents a broad range of maladaptive behaviour, which has been linked to both personality disorder and schizophrenia spectrum disorders; however, to date, little effort has been devoted to developing psychosocial treatment approaches to address it. In response, we conducted two case studies exploring the effects of two metacognitively oriented forms of psychotherapy: metacognitive interpersonal therapy and metacognitive reflection and insight therapy for patients with schizotypal personality disorder. We chose these two forms of therapy as they have been successfully delivered, respectively, to persons with other personality disorders and schizophrenia spectrum disorders. Both treatments consisted of weekly individual psychotherapy sessions over a period of 6 months. General symptoms were assessed during the first week of treatment, at treatment end and at 1 month following treatment using the Symptom Check List-90-Revised, while schizotypal traits were assessed with the Structured Clinical Interview for DSM-5. Both patients completed all sessions, and there were no reports of any adverse outcomes. Both patients achieved reliable change in symptoms (ranging from 4.98 to 9.81) and a significant reduction in schizotypal features. Results provide preliminary evidence of the feasibility of metacognitively oriented interventions for schizotypal personality disorder. © 2019 John Wiley & Sons, Ltd.


Assuntos
Metacognição , Psicoterapia/métodos , Transtorno da Personalidade Esquizotípica/terapia , Adulto , Feminino , Humanos , Masculino , Transtorno da Personalidade Esquizotípica/psicologia , Resultado do Tratamento , Adulto Jovem
10.
Am J Psychiatry ; 176(4): 307-314, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30654644

RESUMO

OBJECTIVE: Impaired cognition is a hallmark of schizophrenia spectrum disorders, including schizotypal personality disorder, and it is the best predictor of functional outcome. Cognitive remediation therapy has demonstrated efficacy for improving cognition, augmenting other rehabilitation efforts in schizophrenia, and effecting gains in real-world functioning. Pharmacological augmentation of cognitive remediation has been attempted, but the effects of augmentation on combined therapies, such as cognitive remediation and social skills training, have not been studied. METHODS: Twenty-eight participants with schizotypal personality disorder enrolled in an 8-week, randomized, double-blind, placebo-controlled trial of guanfacine plus cognitive remediation and social skills training (15 guanfacine, 13 placebo). Cognition was assessed with the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery (MCCB), social cognition with the Movie for the Assessment of Social Cognition (MASC), and functional capacity with the University of California San Diego Performance-Based Skills Assessment (UPSA). RESULTS: A statistically significant pre- versus posttreatment effect was observed for MCCB speed of processing, verbal learning, and visual learning and UPSA total score. A significant time-by-medication (guanfacine, placebo) interaction was observed for MCCB reasoning and problem solving and UPSA total score; the time-by-treatment interaction approached significance for MASC hypomentalizing errors. CONCLUSIONS: Both guanfacine and cognitive remediation plus social skills training were well tolerated, with no side effects or dropouts. Participants treated with cognitive remediation, social skills training, and guanfacine demonstrated statistically significant improvements in reasoning and problem solving, as well as in functional capacity and possibly social cognition, compared with those treated with cognitive remediation, social skills training, and placebo. Cognitive remediation plus social skills training may be an appropriate intervention for individuals with schizotypal personality disorder, and guanfacine appears to be a promising pharmaceutical augmentation to this psychosocial intervention.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Remediação Cognitiva/métodos , Guanfacina/uso terapêutico , Transtorno da Personalidade Esquizotípica/terapia , Habilidades Sociais , Adulto , Terapia Combinada , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos
11.
Schizophr Res ; 199: 414-419, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29661523

RESUMO

BACKGROUND: While individuals at ultra-risk for schizophrenia are characterized by high negative/disorganised but low positive schizotypy, schizophrenia patients are usually high in all three schizotypy facets. Thus, avoiding increases in positive schizotypy in ultra-high risk individuals may constitute of form of schizophrenia-prevention. A possible method of reducing positive schizotypy could be Positive-Psychological intervention (PI). METHODS: We present results from 2 independent studies, including a 12-month follow-up from study 1, using an easy-to-perform intervention based on Positive Psychology to reduce positive schizotypy. RESULTS: A PI can significantly and sustainably reduce positive schizotypy compared to a placebo-condition. Furthermore, our results show very high response-rates to said intervention, with responsiveness to the intervention increasing significantly with disorganised schizotypic traits. CONCLUSIONS: As especially disorganised schizotypy is of relevance for the risk of transition from high benign schizotypy to schizophrenia and is found most closely associated to familial schizophrenia-risk and highly elevated in at-risk mental states, our results are encouraging. We suggest, thus, that positive psychology can not only reduce positive schizotypy, but may be increasingly useful with rising schizophrenia-risk and, thus, be worthy of further investigation regarding it potential in schizophrenia-prevention.


Assuntos
Avaliação de Resultados em Cuidados de Saúde , Psicoterapia/métodos , Transtornos Psicóticos/prevenção & controle , Esquizofrenia/prevenção & controle , Transtorno da Personalidade Esquizotípica/terapia , Adolescente , Adulto , Suscetibilidade a Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Schizophr Res ; 197: 550-556, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29463457

RESUMO

BACKGROUND: Traditionally, research in the ultra-high risk (UHR) for psychosis population has focused on the treatment of existing symptomatology and prevention of transition to psychosis. Recently, there has been an increase in focus on outcomes in individuals who do not transition to psychosis. However, there is a lack of standardised definitions of remission, recovery, recurrence and relapse in UHR, resulting in the inability to generalise and replicate outcomes. METHOD: The aims of the current study were to develop definitions for remission, recovery, recurrence and relapse, and apply them to a UHR cohort allowing the identification of longitudinal clinical trajectories. Further stratification in broader categories of favourable and unfavourable outcomes was applied. The predictive value of various baseline factors on specific clinical trajectories was also assessed. RESULTS: 17 different trajectories were identified in a cohort of 202 individuals within a 12-month period and classified according to the suggested definitions for recovery (35.7%), remission (7.5%), any recurrence (20%), no remission (17.3%), relapse (4.0%) and transition to psychosis (15.8%). Favourable and unfavourable trajectories represented 43.2% and 57.1% respectively. Long duration of untreated symptoms and high depression scores were associated with unfavourable outcomes. DISCUSSION: It is possible to apply clear definitions of remission, recovery, recurrence, relapse and transition to psychosis to a UHR cohort to evaluate longitudinal clinical trajectories. Acceptance and use of these definitions will help to facilitate comparisons between trials and to improve clinical clarity across the range of available therapeutic options in UHR individuals.


Assuntos
Progressão da Doença , Avaliação de Resultados em Cuidados de Saúde , Transtornos Psicóticos/classificação , Transtorno da Personalidade Esquizotípica/classificação , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Indução de Remissão , Risco , Transtorno da Personalidade Esquizotípica/fisiopatologia , Transtorno da Personalidade Esquizotípica/terapia , Adulto Jovem
13.
Z Evid Fortbild Qual Gesundhwes ; 126: 13-22, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29029972

RESUMO

PURPOSE: This paper describes the development of quality indicators for an external statutory and cross-sectoral quality assurance (QA) procedure in the context of the German health care system for adult patients suffering from schizophrenia, schizotypal and delusional disorders (F20-F29). METHODS: Indicators were developed by a modified RAND/UCLA Appropriateness Method with 1) the compilation of an indicator register based on a systematic literature search and analyses of health care claims data, 2) the selection of indicators by an expert panel that rated them for relevance and for feasibility regarding implementation. Indicators rated positive for both relevance and feasibility formed the final indicator set. RESULTS: 847 indicators were identified by different searches. Out of these, 56 were selected for the indicator register. During the formal consensus process the expert panel recommended another 45 indicators so that a total of 101 indicators needed to be considered by the panel. Of these, 27 indicators rated both relevant and feasible were included in the final set of indicators: this set included 4 indicators addressing structures, 19 indicators addressing processes and 4 indicators addressing outcomes. 17 indicators of the set will be reported by hospitals and 8 by psychiatric outpatient facilities. Two indicators considered to be cross-sectoral will be reported by both sectors. DISCUSSION: F20-F29 and its treatment show some specific features which so far have not been addressed by any procedure within the statutory QA program of the German health care system. These features include: Schizophrenia and related disorders a) are potentially chronic conditions, b) are mainly treated in outpatient settings, c) require a multi-professional treatment approach and d) are treated regionally in catchment areas. These specific features in combination with the peculiarities of some legal, political and organizational characteristics of the German health care system and its statutory QA program have strongly influenced the development of indicators. The result was a seemingly "imbalanced" set of indicators with a greater number of indicators for inpatient than for outpatient care despite the fact that clinical reality is otherwise. CONCLUSIONS: The circumstances of the German health care system that restricted the development of this cross-sectoral QA procedure addressing care for F20-F29 are also most likely to emerge with the development of cross-sectoral QA procedures for other (potentially) chronic conditions that are mainly treated in the outpatient setting by multi-professional teams or by networks of different providers. In order to be able to develop a QA procedure that mirrors the reality of service provision for (potentially) chronic diseases such as F20-F29 we need to explore further current and new data sources, diminish sectoral borders, and implement health care responsibility on the level of catchment areas.


Assuntos
Serviços de Saúde Mental/organização & administração , Programas Nacionais de Saúde , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Esquizofrenia Paranoide/terapia , Esquizofrenia/terapia , Transtorno da Personalidade Esquizotípica/terapia , Benchmarking/legislação & jurisprudência , Benchmarking/organização & administração , Benchmarking/normas , Área Programática de Saúde/legislação & jurisprudência , Documentação/métodos , Documentação/normas , Alemanha , Setor de Assistência à Saúde/legislação & jurisprudência , Setor de Assistência à Saúde/organização & administração , Setor de Assistência à Saúde/normas , Humanos , Serviços de Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/normas , Programas Nacionais de Saúde/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/legislação & jurisprudência , Indicadores de Qualidade em Assistência à Saúde/normas , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicologia , Psicologia do Esquizofrênico , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/psicologia
14.
Schizophr Res ; 182: 24-30, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27760701

RESUMO

BACKGROUND: Previous studies report that 20% to 30% of those initially diagnosed with schizotypal disorder go on to develop a psychotic disorder (predominantly schizophrenia). Schizotypal disorder share some traits of those used to identify patients at ultra-high risk for psychosis. METHOD: As part of a randomized clinical trial testing the effect of prolonged specialized early intervention, we recruited 83 participants diagnosed with a schizotypal disorder. Participants were recruited 18 months into their two-year treatment program, and follow-up interviews were conducted three and a half year later. They were randomized to either discontinuation after the standard two year treatment or continuation of the specialized treatment for totally five year. The study investigated whether prolonged treatment could affect the rate of transition to psychosis and other clinical outcomes, and what would predict transition to psychosis. RESULTS: Of those 59 who attended the follow-up interview 19 (32%) developed a psychotic disorder at follow-up. There were no differences between the two treatment groups on transition rates or clinical outcomes. We found that lower level of functioning at baseline predicted transition to psychosis. DISCUSSION: Comparable to previous ultra-high risk studies, we found that level of functioning was the strongest predictor of transition to psychosis. Prior studies have found effect of specialized early intervention on transition rates, but we were not able to reproduce this finding. This may be attributable to the intervention in our study occurring at a later stage in the illness than prior studies.


Assuntos
Intervenção Educacional Precoce , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/terapia , Adulto , Dinamarca , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Avaliação de Resultados em Cuidados de Saúde , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Análise de Regressão , Fatores de Risco , Adulto Jovem
15.
J Nerv Ment Dis ; 205(1): 15-22, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27922907

RESUMO

We investigated stability and change in personality disorder (PD) symptoms and whether depression severity, comorbid clinical psychiatric disorders, and social support predict changes in personality pathology among adolescent outpatients. The 1-year outcome of PD symptoms among consecutive adolescent psychiatric outpatients with depressive disorders (N = 189) was investigated with symptom count of depression, comorbid psychiatric disorders, and perceived social support as predictors. An overall decrease in PD symptoms in most PD categories was observed. Decreases in depression severity and in number of comorbid diagnoses correlated positively with decreases in PD symptoms of most PD categories. Social support from close friends predicted a decrease in schizotypal and narcissistic, whereas support from family predicted a decrease in paranoid symptoms. Our results suggest that among depressed adolescent outpatients, PD symptoms are relatively unstable, changes co-occuring with changes/improvement in overall psychopathology. Social support seems a possibly effective point for intervention efforts regarding positive outcome of PD symptoms.


Assuntos
Transtorno Depressivo/fisiopatologia , Progressão da Doença , Transtornos da Personalidade/fisiopatologia , Apoio Social , Adolescente , Adulto , Comorbidade , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Masculino , Pacientes Ambulatoriais , Transtorno da Personalidade Paranoide/epidemiologia , Transtorno da Personalidade Paranoide/fisiopatologia , Transtorno da Personalidade Paranoide/terapia , Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/terapia , Transtorno da Personalidade Esquizotípica/epidemiologia , Transtorno da Personalidade Esquizotípica/fisiopatologia , Transtorno da Personalidade Esquizotípica/terapia , Índice de Gravidade de Doença , Adulto Jovem
16.
Early Interv Psychiatry ; 11(2): 171-176, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-26472539

RESUMO

AIM: We explored whether cognitive performance, and verbal learning in particular, predicts psychosis or psychiatric hospitalizations among unselected first-admission adolescent patients in general psychiatric care. METHODS: Up to 152 adolescents aged 15-18 were interviewed with the SIPS, tested with a cognitive test battery in the beginning of their psychiatric treatment, and followed for a maximum of 9 years (median 4.5 years). RESULTS: The composite factors of processing speed, verbal performance and visuospatial performance did not predict psychosis (n = 7) or all-cause psychiatric hospitalizations (n = 26) beyond psychosis risk symptoms. However, those who developed psychosis performed worse on California Verbal Learning Test (CVLT) compared to other adolescents. Lower scores of CVLT immediate recall predicted psychosis (P = .003, HR = 1.13 per CVLT point decrease). However, when general verbal ability was adjusted for, CVLT did not reach significance. CONCLUSIONS: Impaired verbal list learning may predict psychosis also among adolescent psychiatric patients not preselected for psychosis risk suspicion.


Assuntos
Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Testes Neuropsicológicos/estatística & dados numéricos , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/psicologia , Aprendizagem Verbal , Adolescente , Aptidão , Transtornos Cognitivos/terapia , Feminino , Finlândia , Humanos , Masculino , Valor Preditivo dos Testes , Sintomas Prodrômicos , Estudos Prospectivos , Psicometria , Medição de Risco , Transtorno da Personalidade Esquizotípica/terapia
17.
Schizophr Res ; 176(2-3): 533-539, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27341953

RESUMO

INTRODUCTION: We aimed to examine changes over time in the incidence of broad and narrow schizophrenia spectrum disorders in Denmark from 2000 to 2012. METHODS: Patients were classified as incident schizophrenia if registered with a first time in- or outpatient contact with relevant diagnostic codes in the Danish Psychiatric Central Register between 2000 and 2012. Their history of contacts was traced back to 1969. Broad schizophrenia included schizophrenia, schizotypal disorder, persistent delusional disorder, acute and transient psychotic disorders, schizoaffective disorders, and other nonorganic and unspecified psychotic disorders, (ICD 10 codes F20-F29). Narrow schizophrenia was defined with the ICD 10 codes F20.0-F20.9. Incidence rates (IR) and incidence rate ratios (IRR) were calculated using Poisson regression. RESULTS: The IRR for broad schizophrenia increased by 1.43 (CI 95% 1.34-1.52) for females and 1.26 (CI 95% 1.20-1.33) for males. IRR for narrow schizophrenia increased by 1.36 (CI 95% 1.24-1.48) for females and 1.20 (CI 95% 1.11-1.29) for males. There was a significantly increased incidence in patients up to 32years of age. This was mainly explained by a significant 2-3 fold increase in outpatient incidence. We found a significant decrease in IRR for patients with broad and narrow schizophrenia aged 33 or older for both in- and outpatients. CONCLUSION: The increased incidence of schizophrenia could partly be explained by better implementation of the diagnostic criteria for schizophrenia in child and adolescent psychiatry and improved access to early intervention services, but a true increase in incidence of schizophrenia cannot be excluded. The decrease of incidence in the older age group could indicate that the national Danish early intervention strategy was successful.


Assuntos
Transtornos Psicóticos/epidemiologia , Esquizofrenia/epidemiologia , Transtorno da Personalidade Esquizotípica/epidemiologia , Adolescente , Adulto , Fatores Etários , Assistência Ambulatorial , Criança , Pré-Escolar , Delusões/diagnóstico , Delusões/epidemiologia , Delusões/terapia , Dinamarca/epidemiologia , Feminino , Hospitalização , Humanos , Incidência , Masculino , Estudos Prospectivos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Sistema de Registros , Análise de Regressão , Esquizofrenia/diagnóstico , Esquizofrenia/terapia , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/terapia , Fatores Sexuais , Adulto Jovem
18.
BMC Psychiatry ; 15: 121, 2015 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-26017268

RESUMO

BACKGROUND: Research is scarce with regard to the role of psychotic and schizotypal symptoms in treatment of obsessive-compulsive disorder (OCD). The aim of the current study was to investigate the occurrence and specificity of psychotic and schizotypal symptoms among non-psychotic OCD patients, and to examine whether such symptoms was associated with response to exposure and response prevention (ERP), and whether ERP for OCD had an impact on psychotic and schizotypal symptoms. METHODS: Non-psychotic OCD patients (n = 133) and a general non-psychotic psychiatric outpatient sample (n = 110) were assessed using self-report inventories before and after psychological treatment. RESULTS: Non-psychotic OCD patients did not report greater degree of psychotic or schizotypal symptoms than the control group. Psychotic and schizotypal symptoms were not associated with OCD symptoms before or after ERP. Psychotic and schizotypal symptom were significantly reduced following ERP. CONCLUSIONS: Psychotic and schizotypal symptoms seem to be equally prevalent among non-psychotic OCD patients and non-psychotic psychiatric controls. These symptoms were more linked to depressive symptoms than OCD symptoms. In non-psychotic OCD patients, ERP seems sufficient in reducing OCD symptoms despite the presence of psychotic- and schizotypal symptoms, and reductions in psychotic- and schizotypal symptoms were observed following ERP.


Assuntos
Transtorno Obsessivo-Compulsivo/diagnóstico , Transtornos Psicóticos/diagnóstico , Transtorno da Personalidade Esquizotípica/diagnóstico , Adulto , Feminino , Humanos , Terapia Implosiva , Masculino , Transtornos Mentais/terapia , Transtorno Obsessivo-Compulsivo/complicações , Transtorno Obsessivo-Compulsivo/terapia , Inventário de Personalidade , Transtornos Psicóticos/complicações , Transtornos Psicóticos/terapia , Transtorno da Personalidade Esquizotípica/complicações , Transtorno da Personalidade Esquizotípica/terapia , Autorrelato , Avaliação de Sintomas , Adulto Jovem
20.
Psychiatry Res ; 225(1-2): 93-98, 2015 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-25467705

RESUMO

Individuals at clinical high risk (CHR) of psychosis evidence cognitive deficits. Given suggestions that deficits in cognition are related to poor functional outcome, cognition is a good treatment target. The aim of this study was to test the efficacy of cognitive remediation therapy (CRT) in improving cognition of CHR individuals. Participants were tested at baseline, immediately following CRT and 9 months post-baseline. The mixed effects modelling demonstrated no differences in cognition between the experimental group and the control group at any time point. For the experimental group, however, there was a trend towards improvement in speed of processing between baseline and 9-month follow-up (t(29)=-2.91, P=0.06) and at post-CRT compared to 9-month follow-up (t(29)=-2.99, P<0.05). In the control group, significant improvements in working memory were observed between post-CRT and 9-month follow-up (t(29)=-3.06, P<0.05). Despite significant improvements in social functioning in the intervention group between baseline and 9-month follow-up (t(28)=-3.26, P<0.05), these improvements were not correlated with cognition. There were trends towards improvement and no trends of decline in the two groups. While CRT may be valuable for individuals at CHR, the type of intervention employed needs to be carefully considered.


Assuntos
Transtornos Cognitivos/terapia , Testes Neuropsicológicos/estatística & dados numéricos , Ensino de Recuperação/métodos , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Transtorno da Personalidade Esquizotípica/terapia , Adolescente , Adulto , Alberta , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Seguimentos , Humanos , Masculino , Memória de Curto Prazo , Projetos Piloto , Psicometria , Risco , Esquizofrenia/diagnóstico , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/psicologia , Método Simples-Cego , Adulto Jovem
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