Basic symptoms of schizophrenia are related to symptoms of traumatic stress: A pivotal role of sensitization. An observational study.

INTRODUCTION: Subjective cognitive deficits have been broadly reported in schizophrenia and described by Huber as basic symptoms. It remains unclear however to what extent they may be related to psychosocial stressors including trauma. METHODS: We assessed basic symptoms using the Frankfurt Complaint Questionnaire (FCQ) in a sample of 40 patients with schizophrenia. Trauma-related symptoms were assessed concurrently using the Trauma Symptom Checklist-40, symptoms of dissociation using the Dissociative Experiences Scale, and sensitization phenomena using the Complex Partial Seizure-like Symptoms Inventory and Limbic System Checklist-33. Psychotic symptoms were measured by Health of the Nation Outcome Scales. The dosage of antipsychotic medication was assessed in terms of equivalents of chlorpromazine, and antidepressant medication in terms of equivalents of fluoxetine. Spearman correlations were performed to explore the relationship between FCQ and other trauma-related measures. To determine the relative contributions of trauma-related symptoms to basic symptoms a linear regression analysis was performed. RESULTS: The results showed that higher levels of basic symptoms of schizophrenia were associated with greater levels of symptoms of dissociation, traumatic stress, and sensitization or kindling-like processes in schizophrenia. Among the trauma-related variables, sensitization phenomena assessed with Complex Partial Seizure-like Symptoms Inventory were closely associated with basic symptoms. DISCUSSION: These results indicate that basic symptoms measured by FCQ might be related to trauma. The potential of trauma to influence neurodevelopmental hypotheses of schizophrenia is discussed.

Psychosocial Stress, Epileptic-Like Symptoms and Psychotic Experiences.

Background: Current research suggests that stressful life experiences and situations create a substantive effect in the development of the initial manifestations of psychotic disorders and may influence temporo-limbic epileptic-like activity manifesting as cognitive and affective seizure-like symptoms in non-epileptic conditions. Methods: The current study assessed trauma history, hair cortisol levels, epileptic-like manifestations and other psychopathological symptoms in 56 drug naive adult young women experiencing their initial occurrence of psychosis. Results: Hair cortisol levels among patients experiencing their initial episode of psychosis, were significantly correlated with stress symptoms measured by Trauma Symptom Checklist-40 (r = - 0.48, p < 0.01), and complex partial seizure-like symptoms measured by the Complex Partial Seizure-Like Symptoms Inventory (r = - 0.33, p < 0.05) and LSCL-33 (r = - 0.33, p < 0.05). Hair cortisol levels were not found to be significantly correlated with symptoms of anxiety and depression measured by Beck depression Inventory and Zung Anxiety Scale. Conclusion: These findings suggest a significant relationship between epileptic-like symptoms and stress responses demonstrated by patients in their first psychotic episode. These findings may suggest the potential for research to explore usefulness of anticonvulsant treatment in patients who do not respond to usual psychotropic medication.

Psychodynamic day treatment program for borderline personality disorder: factors that predict outcome and dropout: An observational study.

ABSTRACT: The objective of this study was to ascertain changes in symptoms of patients with borderline personality disorder undergoing psychodynamic day treatment with a duration of 9 months and the factors that predict clinical outcome or dropouts from the program.In an observational study, demographic characteristics (age, number of psychiatric hospitalizations, number of suicide attempts, current involvement in work or study activities), day doses of antipsychotic and antidepressant medication, psychiatric symptoms, and social functioning (Health of the Nation Outcome Scales), and symptoms of dissociation (Dissociative Experiences Scale) were assessed in patients at the beginning of treatment (N = 105). Further, psychiatric symptoms and social functioning were assessed at 3 stages: beginning of the program, end of the program, and 1-year follow-up. To study the differences between baseline values and values at the end of the treatment and follow-up values, the Wilcoxon signed-rank test was used. To discover baseline factors related to the effect of the treatment, Spearman correlation coefficients were calculated. To evaluate the differences between patients who completed the program (N = 67) and patients who dropped out (N = 38), differences in baseline factors between both groups were compared, using the Mann-Whitney test for independent samples.Improvement in symptoms (Health of the Nation Outcome Scales - version for external evaluators) at the end of the therapy (N = 67, P < .001) and at the 1-year follow-up (N = 46, P < .001) was found. Experience of an intimate relationship was positively related to clinical improvement at follow-up examinations (P < .001). Predictors of dropout included a higher number of psychiatric hospitalizations (P = .004), suicide attempts (P = .004), more severe pretreatment symptoms (P = .002), and symptoms of dissociation (P = .046).The results indicate that a psychodynamic day treatment is feasible for the treatment of less clinically disturbed patients with a history of intimate relationships. Patients with a higher number of previous psychiatric hospitalizations, more suicide attempts in the past, more severe pretreatment symptoms, and symptoms of dissociation are more likely not to complete the program.

Stages of recovery in psychosis: Converging qualitative research and psychoanalysis.

PURPOSE: The purpose of this study is to find common points of view between the results of qualitative studies researching stages of the recovery process in persons with psychosis and mental changes in a therapeutic relationship in psychoanalytically oriented psychotherapy. CONCLUSIONS: Both concepts correspond one to another. The added psychoanalytical perspective highlights milestones in psychic change: attainment of mental differentiation; integration of self together with the transformation of psychotic grandiosity into decentration, which implies responsibility for illness and own life. PRACTICE IMPLICATIONS: These conclusions highlight the importance of supporting relationships for people suffering from psychoses.

Mental health reforms in the Czech Republic.

This paper describes the history and current provision of mental healthcare in the Czech Republic. After the political changes in 1989, there was an expansion of out-patient care and several non-governmental organisations began to provide social rehabilitation services, but the main focus of care still rested on mental hospitals. In recent years, mental health reform has been in progress, which has involved expanding community-based services and psychiatric wards of general hospitals, simultaneously with educational and destigmatisation programmes.

Dissociative states in borderline personality disorder and their relationships to psychotropic medication.

BACKGROUND: According to recent data, dissociation may play an important role in borderline personality disorder (BPD), nevertheless specific influences of psychotropic medication on dissociative symptoms in BPD and their therapeutic indications are largely unknown. The purpose of this study was to assess relationships of dissociative symptoms in BPD patients with levels of psychotropic medication and compare these results with a subgroup of patients with schizophrenia. MATERIALS AND METHODS: In this study, we investigated 52 BPD patients and compared the results with a control group of 36 schizophrenia patients. In all participants, we assessed actual day doses of antipsychotic medication in chlorpromazine equivalents and antidepressant medication in fluoxetine equivalents. Dissociative symptoms were measured by Dissociative Experiences Scale (DES), and other psychopathological symptoms were measured using Health of the Nation Outcome Scales. RESULTS: Results indicate that dissociative symptoms measured by DES were significantly correlated with antipsychotic medication (Spearman R=0.45, P<0.01) in chlorpromazine equivalents and antidepressant medication in fluoxetine equivalents (0.36, P<0.01). These relationships between medication and dissociative symptoms were not found in the control group of schizophrenia patients. CONCLUSION: The results suggest that levels of antipsychotic medication and antidepressant medication are significantly associated with dissociative symptoms in BPD but not in schizophrenia.

Psychodynamic day treatment programme for patients with schizophrenia spectrum disorders: Dynamics and predictors of therapeutic change.

OBJECTIVES: The purpose of this study was to test whether a psychodynamically based group psychotherapeutic programme might improve symptoms, social functions, or quality of life in patients with schizophrenia spectrum disorders and to investigate factors that might predict clinical improvement or dropouts from the programme. DESIGN: A quantitative prospective cohort study. METHODS: We have investigated 81 patients with schizophrenia spectrum disorders who participated in a 9-month psychodynamically based psychotherapeutic day programme. The patients were assessed at the beginning and end of the programme, and then at 1-year follow-up. The assessment included psychotic manifestations (HoNOS), quality of life (WHOQOL-BREF), demographic data, and daily doses of medication. 21 patients dropped out from the programme, and 46 patients succeeded in undergoing follow-up assessment. RESULTS: The psychotic manifestations (self-rating version of HoNOS) and quality of life measured with WHOQOL-BREF (domains of social relationships and environment) were significantly improved at the end of the programme and at follow-up. However, the manifestations on the version for external evaluators of HoNOS were improved only at follow-up. Years of psychiatric treatment, number of hospitalizations or suicide attempts, and experience of relationships with a partner were negatively related to clinical improvement, whereas symptom severity, current working, or study activities were related positively. CONCLUSIONS: The results show that a group psychodynamic programme may improve the clinical status and quality of life of patients with schizophrenia spectrum disorders. This type of programme is more beneficial for patients with higher pre-treatment symptom severity and the presence of working or study activities. PRACTITIONER POINTS: A psychodynamically based group programme improves the clinical status and quality of life in patients with schizophrenia spectrum disorders. Data indicate that changes on the subjective level are detectable by the end of the programme, while changes on the objective level are detectable at follow-up assessment. Symptom severity and working or study activities are positively related to the clinical improvement in this type of programme, while a high number of years in psychiatric treatment or psychiatric hospitalizations are negatively related. The doses of medication (antipsychotics or antidepressants) show no significant relationship to clinical improvement.

Contrasting metacognitive, social cognitive and alexithymia profiles in adults with borderline personality disorder, schizophrenia and substance use disorder.

Deficits in the ability to recognize and think about mental states are broadly understood to be a root cause of dysfunction in Borderline Personality Disorder (PD). This study compared the magnitude of those deficits relative to other forms of serious mental illness or psychiatric conditions. Assessments were performed using the metacognition assessment scale-abbreviated (MAS-A), emotion recognition using the Bell Lysaker Emotion Recognition Test and alexithymia using the Toronto Alexithymia Scale among adults with schizophrenia (n = 65), Borderline PD (n = 34) and Substance Use disorder without psychosis or significant Borderline traits (n = 32). ANCOVA controlling for age revealed the Borderline PD group had significantly greater levels of metacognitive capacity on the MAS-A than the schizophrenia group and significantly lower levels of metacognitive capacity than the Substance Use group. Multiple comparisons revealed the Borderline PD group had significantly higher self-reflectivity and awareness of the other's mind than the schizophrenia group but lesser mastery and decentration on the MAS-A than substance use group, after controlling for self-report of psychopathology and overall number of PD traits. The Borderline PD and Schizophrenia group had significantly higher levels of alexithymia than the substance use group. No differences were found for emotion recognition. Results suggest metacognitive functioning is differentially affected in different mental disorders.

Conscious brain, metacognition and schizophrenia.

Recent findings indicate that the binding and synchronization of distributed neural activities are crucial for cognitive processes and consciousness. In addition, there is increasing evidence that disrupted feature binding is related to experiences of disintegration of consciousness in schizophrenia. These data suggest that the disrupted binding and disintegration of consciousness could be typically related to schizophrenia in terms of Bleuler's concept of "splitting". In this context, deficits in metacognitive capacity in schizophrenia may be conceptualized as a spectrum from more discrete to more synthetic activities, related to specific levels of neural binding and neurocognitive deficits. This review summarizes the recent research on metacognition and its relationship to deficits of conscious awareness that may be found in schizophrenia patients. Deficits in synthetic metacognition are likely linked to the integration of information during specific processes of neural binding. Those in turn may be related to a range of mental activities including reasoning style, learning potential and insight.

Dissociation in schizophrenia and borderline personality disorder.

BACKGROUND: Dissociation likely plays a key role in schizophrenia and borderline personality disorder (BPD), although empirical studies that compare specific manifestations of these symptoms in schizophrenia and BPD are rare. In this context, the purpose of this study was to compare the occurrence of dissociative and other psychopathological symptoms in these disorders, and to assess the possible influence of antipsychotic medication on the dissociative symptoms. METHODS: We assessed 31 patients with schizophrenia and 36 patients with BPD. Dissociative symptoms were measured by the Dissociative Experiences Scale (DES), symptoms related to stress and traumatic experiences were assessed using the Trauma Symptom Checklist-40 (TSC-40), and other psychopathological symptoms were measured with the Health of the Nation Outcome Scales (HoNOS). We also assessed actual daily doses of antipsychotic medication in chlorpromazine equivalents in all participants. RESULTS: The results show that symptoms of traumatic stress measured by the TSC-40 had significantly higher scores in the BPD group. The data also show that dissociative symptoms (DES) were significantly correlated with symptoms of traumatic stress (TSC-40) and with symptoms assessed by the HoNOS. Remarkably significant correlations were found between levels of antipsychotic medication and the DES and between antipsychotic medication and the depersonalization/derealization component of the DES in BPD patients. CONCLUSION: The results support an important role of dissociative processes in schizophrenia and BPD and suggest a significant relationship between manifestations of dissociative symptoms in BPD and antipsychotic medication.

Splitting in schizophrenia and borderline personality disorder.

BACKGROUND: Splitting describes fragmentation of conscious experience that may occur in various psychiatric disorders. A purpose of this study is to examine relationships between psychological process of splitting and disturbed cognitive and affective functions in schizophrenia and borderline personality disorder (BPD). METHODS: In the clinical study, we have assessed 30 patients with schizophrenia and 35 patients with BPD. The symptoms of splitting were measured using self-reported Splitting Index (SI). As a measure of semantic memory disorganization we have used verbal fluency test. Other psychopathological symptoms were assessed using Health of the Nation Outcome Scale (HoNOS). RESULTS: Main results show that SI is significantly higher in BPD group than in schizophrenia, and on the other hand, verbal fluency is significantly lower in schizophrenia group. Psychopathological symptoms measured by HoNOS are significantly higher in the BPD group than in schizophrenia. Significant relationship was found between verbal fluency and the SI "factor of others" (Spearman r = -0.52, p<0.01) in schizophrenia patients. CONCLUSIONS: Processes of splitting are different in schizophrenia and BPD. In BPD patients splitting results to mental instability, whereas in schizophrenia the mental fragmentation leads to splitting of associations observed as lower scores of verbal fluency, which in principle is in agreement with Bleuler's historical concept of splitting in schizophrenia.

The state of psychiatry in the Czech Republic.

This overview of Czech psychiatry begins with a brief review of its history; outlines its social, political and economic determinants and then describes the field itself. Both epidemiological and service-related information are discussed, together with the issues for mental health personnel, education and research. The heavy burden of communist history pervades most areas and must be taken into account in the specific characteristics that influence both the current situation and future prospects of Czech psychiatry. This consideration is essential for orientation in the field and to understand Czech particularities. The greatest challenges, however, originate from the fundamental changes that are going on in the world today. These challenges reach beyond national boundaries and include such phenomena as globalization, migration, ageing population, growing burden of mental ill health, the still prevailing stigma towards psychiatry, and the psychological roots and consequences of current financial and societal crises.