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2.
Nat Commun ; 11(1): 4250, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32843635

RESUMO

A mechanistic understanding of core cognitive processes, such as working memory, is crucial to addressing psychiatric symptoms in brain disorders. We propose a combined psychophysical and biophysical account of two symptomatologically related diseases, both linked to hypofunctional NMDARs: schizophrenia and autoimmune anti-NMDAR encephalitis. We first quantified shared working memory alterations in a delayed-response task. In both patient groups, we report a markedly reduced influence of previous stimuli on working memory contents, despite preserved memory precision. We then simulated this finding with NMDAR-dependent synaptic alterations in a microcircuit model of prefrontal cortex. Changes in cortical excitation destabilized within-trial memory maintenance and could not account for disrupted serial dependence in working memory. Rather, a quantitative fit between data and simulations supports alterations of an NMDAR-dependent memory mechanism operating on longer timescales, such as short-term potentiation.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/fisiopatologia , Memória de Curto Prazo/fisiologia , Esquizofrenia/fisiopatologia , Sinapses/fisiologia , Adolescente , Adulto , Encefalite Antirreceptor de N-Metil-D-Aspartato/psicologia , Feminino , Humanos , Masculino , Modelos Neurológicos , Rede Nervosa/fisiopatologia , Plasticidade Neuronal , Córtex Pré-Frontal/fisiopatologia , Receptores de N-Metil-D-Aspartato/fisiologia , Psicologia do Esquizofrênico , Adulto Jovem
3.
S Afr Fam Pract (2004) ; 62(1): e1-e4, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32787389

RESUMO

Medical practitioners are confronted daily with decisions about patients' capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end-of-life decision-making capacity of a 72-year-old female with treatment-resistant schizophrenia and terminal cancer is discussed, as are the role of the treating clinician and the importance of health-related values. There is a recommendation that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient's wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient's capacity will change the treatment approach. Clinicians should attend to any possible underlying issues, instead of focusing strictly on capacity. Compared to the general populations people with serious mental illness (SMI) have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services. Conversations about end-of-life care can occur without fear that a person's psychiatric symptoms or related vulnerabilities will undermine the process. More research about palliative care and advance care planning for people with SMI is needed. This is even more urgent in light of the coronavirus disease-2019 (COVID-19) pandemic, and South African health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with SMI.


Assuntos
Tomada de Decisões , Competência Mental/psicologia , Neoplasias/psicologia , Psicologia do Esquizofrênico , Assistência Terminal/psicologia , Idoso , Betacoronavirus , Infecções por Coronavirus/psicologia , Feminino , Humanos , Consentimento Livre e Esclarecido/psicologia , Pandemias , Pneumonia Viral/psicologia , Esquizofrenia
4.
Lancet Psychiatry ; 7(9): 762-774, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32828166

RESUMO

BACKGROUND: People with schizophrenia have higher rates of smoking than the general population, and lower quit rates. Several randomised controlled trials have investigated the effectiveness of pharmacological interventions for smoking cessation over the past 20 years. We did a systematic review and pairwise and network meta-analysis of smoking abstinence to guide decision making in offering pharmacological interventions for smoking cessation for people with schizophrenia spectrum disorders. METHODS: We systematically reviewed PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and China National Knowledge Infrastructure from inception to Sept 30, 2019, for randomised controlled trials of varenicline, bupropion, and nicotine replacement therapy for smoking cessation for people with schizophrenia spectrum disorders or psychotic disorders who were smokers at the time of study recruitment. Data were extracted from published studies on smoking abstinence outcomes and psychotic symptoms. We did pairwise and network meta-analyses for the primary outcome of smoking abstinence. Sensitivity analyses were done on study inclusion criteria, duration, quality, and location. This study is registered with the international prospective register of systematic reviews PROSPERO, CRD42018102343. FINDINGS: A total of 15 111 records were identified by the database searches, and 163 full-text articles were assessed for eligibility. 145 articles were then excluded for several reasons including insufficient data, or abstracts published in later studies, and 18 studies were included in the meta-analysis. In the pairwise meta-analyses, four studies with 394 participants assessed varenicline (RR 3·75, 95% CI 1·96-7·19, p<0·0001; I2=0%), four studies with bupropion and 292 participants (RR 3·40, 95% CI 1·58-7·34, p=0·0002; I2=0%), and three studies with 561 participants assessed nicotine replacement therapy (RR 4·27, 95% CI 1·71-10·65, p=0·0002; I2=0%). All three treatments were deemed superior to placebo. In the network meta-analysis, varenicline was superior to bupropion (RR 2·02, 95% CI 1·04-3·93; p=0·038) but no significant difference was found between varenicline and nicotine replacement therapy, or bupropion and nicotine replacement therapy. No agents were associated with changes in psychiatric symptoms, but varenicline was associated with higher rates of nausea than was placebo. INTERPRETATION: We found evidence to support use of pharmacological agents for smoking cessation for people with psychosis. Varenicline might be superior to bupropion; however, additional direct testing and combination trials of pharmacological agents for smoking cessation are required to inform clinical decision making for people with psychosis. FUNDING: None.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Bupropiona/uso terapêutico , Esquizofrenia , Abandono do Hábito de Fumar/métodos , Humanos , Metanálise em Rede , Nicotina/administração & dosagem , Agonistas Nicotínicos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Psicologia do Esquizofrênico , Vareniclina
6.
Epidemiol Psychiatr Sci ; 29: e156, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32792024

RESUMO

AIMS: Given the concerns of health inequality associated with mental illnesses, we aimed to reveal the extent of which general mortality and life expectancy at birth in people with schizophrenia, bipolar disorder and depressive disorder varied in the 2005 and 2010 nationally representative cohorts in Taiwan. METHODS: Two nationally representative samples of individuals with schizophrenia, bipolar disorder and depressive disorder were identified from Taiwan's national health insurance database in 2005 and 2010, respectively, and followed-up for consecutive 3 years. The database was linked to nationwide mortality registry to identify causes and date of death. Age-, gender- and cause-specific mortality rates were generated, with the average follow-up period of each age- and gender-band applied as 'weighting' for the calculation of expected number of deaths. Age- and gender-standardised mortality ratios (SMRs) were calculated for these 3-year observation periods with Taiwanese general population in 2011/2012 as the standard population. The SMR calculations were then stratified by natural/unnatural causes and major groups of death. Corresponding life expectancies at birth were also calculated by gender, diagnosis of mental disorders and year of cohorts for further elucidation. RESULTS: The general differential in mortality rates for people with schizophrenia and bipolar disorder remained wide, revealing an SMR of 3.65 (95% confidence interval (CI): 3.55-3.76) for cohort 2005 and 3.27 (3.18-3.36) for cohort 2010 in schizophrenia, and 2.65 (95% CI: 2.55-2.76) for cohort 2005 and 2.39 (2.31-2.48) for cohort 2010 in bipolar disorder, respectively. The SMRs in people with depression were 1.83 (95% CI: 1.81-1.86) for cohort 2005 and 1.59 (1.57-1.61) for cohort 2010. SMRs due to unnatural causes tended to decrease in people with major mental illnesses over the years, but those due to natural causes remained relatively stable. The life expectancies at birth for schizophrenia, bipolar disorder and depression were all significantly lower than the national norms, specifically showing 14.97-15.50 years of life lost for men and 15.15-15.48 years for women in people with schizophrenia. CONCLUSIONS: Compared to general population, the differential in mortality rates for people with major mental illnesses persisted substantial. The differential in mortality for unnatural causes of death seemed decreasing over the years, but that due to natural causes remained relatively steady. Regardless of gender, people with schizophrenia, bipolar disorder and depression were shown to have shortened life expectancies compared to general population.


Assuntos
Transtorno Bipolar/mortalidade , Transtorno Depressivo/mortalidade , Disparidades nos Níveis de Saúde , Esquizofrenia/mortalidade , Adulto , Idoso , Transtorno Bipolar/psicologia , Causas de Morte/tendências , Estudos de Coortes , Transtorno Depressivo/psicologia , Feminino , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Psicologia do Esquizofrênico , Fatores Socioeconômicos , Suicídio , Taiwan/epidemiologia
7.
Yonsei Med J ; 61(8): 726-730, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32734737

RESUMO

Language disorganization, an objective component of formal thought process abnormality, has been regarded as a core symptom of schizophrenia from an evolutionary psychopathology perspective. However, to the best of our knowledge, the network structure of language disorganization has rarely been examined in patients with schizophrenia. Thus, our preliminary study aimed to evaluate the network structure using the Clinical Language Disorder Rating Scale (CLANG) in 167 inpatients with schizophrenia. All 17 of the CLANG items were considered to be ordered categorical variables ranging from 0 to 3. Our results indicated that disclosure failure, excess syntactic constraints, abnormal prosody, and aprosodic speech rank among the top five central domains within the network structure. We deemed that disclosure failure and prosody problems are the most important symptoms of language disorder in schizophrenia. Thus, reduced top-down processing of linguistic information may be a core neurobiological underpinning of language disorganization in schizophrenia. Further studies controlling for the potential effects of confounding factors (i.e., duration of illness) on network analyses of language disorder and formal thought disorder are warranted in patients with schizophrenia.


Assuntos
Transtornos da Linguagem/complicações , Transtornos da Linguagem/psicologia , Esquizofrenia/complicações , Psicologia do Esquizofrênico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
PLoS One ; 15(8): e0237614, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776979

RESUMO

The present study employed structured diagnostic interviews to assess the construct validity of the brief version of the Multidimensional Schizotypy Scale (MSS-B), which was developed to assess positive, negative, and disorganized dimensions of schizotypy. It was hypothesized that the MSS-B subscales would be associated with differential patterns of symptoms and impairment, comparable to findings for the full-length MSS. A total of 177 young adults completed structured diagnostic interviews assessing symptoms and impairment. As hypothesized, MSS-B positive schizotypy was significantly associated with interview ratings of positive (psychotic-like) symptoms, as well as schizotypal and paranoid personality disorder traits. MSS-B negative schizotypy was associated with interview ratings of negative symptoms, as well as schizoid, paranoid, and schizotypal traits. Furthermore, negative schizotypy predicted Cluster A personality disorder diagnoses. MSS-B disorganized schizotypy was associated with interview ratings of disorganized symptoms. All three schizotypy dimensions were associated with impaired functioning. This was the first study to evaluate the validity of the MSS-B using interview measures, and the pattern of findings for each MSS-B subscale was closely comparable to the findings for the full-length MSS. Contrary to our hypothesis, cannabis use was largely unassociated with psychotic-like symptoms and did not moderate the expression of the schizotypy dimensions. The MSS-B has good psychometric properties, high concordance with the full-length MSS, and good construct validity. Thus, it appears to be a promising brief alternative to traditional schizotypy measures.


Assuntos
Psicologia do Esquizofrênico , Transtorno da Personalidade Esquizotípica/diagnóstico , Índice de Gravidade de Doença , Inquéritos e Questionários/normas , Adolescente , Adulto , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Transtorno da Personalidade Esquizotípica/psicologia , Adulto Jovem
10.
Soins Psychiatr ; 41(327): 31-32, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32718459

RESUMO

The nurses in the unit for difficult patients at Cadillac hospital have developed an innovative art therapy concept: Melting-Pain Therapy. In this workshop patients produce a collective piece of art created through participants' individual sessions with a nurse. These patients are exclusively men, suffering mainly from schizophrenia, who have been or who are potentially dangerous. The photographs accompanying this article show some examples of these art brut creations.


Assuntos
Terapia pela Arte , Esquizofrenia/terapia , Difusão de Inovações , Humanos , Masculino , Recursos Humanos de Enfermagem no Hospital , Esquizofrenia/enfermagem , Psicologia do Esquizofrênico
11.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(6. Vyp. 2): 13-22, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32729686

RESUMO

The authors consider current and own conceptions about correlations of the processes underlying the pathogenesis of schizophrenia presented by negative and positive disorders. With growth of academic psychiatry, evaluation of a correlation between positive and negative dimensions has changed dramatically: on the one hand presenting in clinical unity - simultaneous psychopathologic structures, and on the other hand being clinically and pathogenetically heterogenic in dimensional structure. According to our clinical and biological findings and an analysis of fundamental neurobiological studies, positive and negative disorders present in the clinical picture of schizophrenia as two separate psychopathological and pathogenetic structures. A new paradigm of the correlation between positive and negative structures - the interaction between positive and deficit symptoms - reveals psychopathological functions differentiated for each of dimensional structures. Negative disorders act as «transformers¼ modifying characteristics of primary transnosological positive disorders to the level of psychopathological structures preferable for schizophrenia; positive disorders, in their turn, act as «moderators¼ augmenting, amplifying manifestations of negative symptoms. This psychopathological construct of the correlation between dimensional structures paves a way for the development of a new concept of psychopharmacological treatment of schizophrenic deficit: both negative symptoms and amplifying positive symptoms are considered as «target symptoms¼ for pharmacological interventions.


Assuntos
Psiquiatria , Esquizofrenia , Humanos , Psicopatologia , Psicologia do Esquizofrênico
12.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(6. Vyp. 2): 23-30, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32729687

RESUMO

OBJECTIVE: To determine the features of the course of young-onset schizophrenia based on the long-term follow-up results (20-25 years). MATERIAL AND METHODS: The results of the long-term follow-up study of 320 patients with young-onset schizophrenia referred for psychiatric care in an outpatient clinic in Moscow from 1990 to 1994 were analyzed. Correlations between typological variants of the patient's condition during the follow-up and features of the dynamics of the schizophrenic process at different stages of the disease were studied. Clinical-psychopathological, clinical follow-up, clinical-epidemiological and a psychometric method were applied. RESULTS AND CONCLUSION: The severity of symptoms at all stages of the disease correlates with typological variants of conditions at the stage of long-term follow-up. In the first type, there is an accumulation of personality desorders and the most prognostically favorable variants of the initial stage, manifestations of psychotic states, the disease often manifests with only one episode and has a regressive character, the disease process fades quite quickly, mainly high-and medium-quality remissions are formed. In the second type, there is an accumulation of less favorable signs - prolonged variants of the initial stage with a predominance of negative disorders, hallucinatory-delusional manifestations of psychoses with exacerbations after 10-12 years, the high frequency of progressive forms of disease course and remissions of moderate to low quality. Type 3 is characterized by the most severe combinations of positive and negative symptoms, paranoid forms of the initial stage, paranoid and catatonic manifestations of psychoses, a high number of relapses at all stages of the course, low-quality remissions and frequent transition of the disease to a continuous form.


Assuntos
Transtornos Psicóticos , Esquizofrenia , Seguimentos , Humanos , Moscou , Psicologia do Esquizofrênico
13.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(6. Vyp. 2): 105-112, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32729698

RESUMO

OBJECTIVE: To explore the relationship between the indicators of quality of life (QOL) and social functioning (SF) of patients with schizophrenia with clinical and socio-demographic characteristics, indicators of cognitive functions and the severity of disease symptoms, using mathematical modeling methods. MATERIAL AND METHODS: The sample consisted of 300 patients with paranoid schizophrenia (aged 18-50 years, disease duration at least 5 years; total PANSS score <120). Clinical-psychopathological, psychometric and mathematical methods were used. A mathematical model based on the construct developed by the authors called the «Disease Burden Factor¼ (Factor «B¼) was utilized. RESULTS AND CONCLUSION: Statistically significant correlations of factor "B" with age, the time of disease onset, seeking psychiatric help and diagnosis, the length of hospital admissions in the past 12 months and PANSS and BACS scores were established. Factor «B¼ clusters of «prosperous¼ and «dysfunctional¼ patients, significantly differing in the frequency of exacerbations of the disease, its total duration, and indicators of QOL-SM, PSP, PANSS, BACS, were distinguished. The conclusion about the reliability and sensitivity of a new toolbox - Factor «B¼ for exploring the mutual influence of heterogeneous factors affecting the trajectory of patients with schizophrenia was made.


Assuntos
Qualidade de Vida , Psicologia do Esquizofrênico , Adolescente , Adulto , Humanos , Lactente , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Psicometria , Reprodutibilidade dos Testes , Ajustamento Social , Adulto Jovem
15.
PLoS One ; 15(7): e0236241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716957

RESUMO

BACKGROUND: Early-Onset Schizophrenia (EOS) is rare but severe mental health disorder in children and adolescents. Diagnosis of schizophrenia before the age of 18 years remains complex and challenging, especially in young children. In France, there are no recent reliable epidemiological data about the prevalence of EOS. The present study evaluates the EOS rate in a target clinical population of children and adolescents in psychiatric and medico-social care centres in the South-East of France. METHODS: Psychiatric and medico-social centres for children and adolescent in the geographical area have been contacted, and after receiving their agreement to participate in the study, eligible patients corresponding to inclusion criteria were selected based on patients' medical records. Main inclusion criteria were age 7 to 17 years and intelligence quotient > 35. EOS categorical diagnosis was assessed by Kiddie-SADS Present and Lifetime psychosis section. RESULTS: 37 centres participated and 302 subjects have been included in the study. The main result was the categorical diagnosis of EOS in 27 subjects, corresponding to a rate of 8.9% in the study population. Half of the patients presented mild to moderate intellectual deficiency. Interestingly, only 2.3% had a diagnosis of schizophrenia spectrum disorder noted in their medical records before standardized assessment. CONCLUSIONS: The results of the study highlight the importance of using a standardized diagnostic tool for the diagnosis of schizophrenia in the paediatric population. In fact, EOS might be underdiagnosed in children and adolescents with neurodevelopmental disorders and subnormal cognitive functioning. TRIAL REGISTRATION: NCT01512641. Registered 19 January 2012; https://clinicaltrials.gov/ct2/show/NCT01512641.


Assuntos
Assistência à Saúde , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Idade de Início , Criança , Cognição , Estudos Transversais , Escolaridade , Feminino , França/epidemiologia , Geografia , Humanos , Recém-Nascido , Testes de Inteligência , Classificação Internacional de Doenças , Masculino , Gravidez , Esquizofrenia/tratamento farmacológico , Esquizofrenia/reabilitação , Fatores Socioeconômicos
16.
J Autism Dev Disord ; 50(8): 3046-3059, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32642956

RESUMO

Social cognition impairment is a core shared phenotype in both schizophrenia spectrum disorders (SSD) and autism spectrum disorders (ASD). This study compares social cognition performance through four different instruments in a sample of 147 individuals with ASD or SSD and in healthy controls. We found that both clinical groups perform similarly to each other and worse than healthy controls in all social cognition tasks. Only performance on the Movie for the Assessment of Social Cognition (MASC) test was independent of age and intelligence. Proportionately, individuals in the control group made significantly more overmentalization errors than both patients group did and made fewer undermentalization errors than patients with SSD did. AUC analyses showed that the MASC was the instrument that best discriminated between the clinical and control groups. Multivariate analysis showed negative symptom severity as a potential mediator of the association between social cognition deficit and poor global functioning.


Assuntos
Transtorno do Espectro Autista/psicologia , Cognição , Psicologia do Esquizofrênico , Comportamento Social , Percepção Social , Adulto , Feminino , Humanos , Inteligência , Masculino , Filmes Cinematográficos , Teoria da Mente
17.
Actas esp. psiquiatr ; 48(3): 116-125, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193797

RESUMO

ANTECEDENTES: Estudios previos sugieren que las personas con esquizofrenia son uno de los grupos más estigmatizados de la sociedad. OBJETIVO: analizar ampliamente el estigma personal en pacientes con esquizofrenia. MÉTODO: Se obtuvieron datos de 89 pacientes. Éstos fueron evaluados con los siguientes instrumentos: características sociodemográficas y clínicas, Escala de Discriminación y Estigma, Cuestionario de Autopercepción del Estigma, Escala de Síndromes positivos y negativos, Escala de depresión de Calgary, Escala de Evaluación de la Actividad Global y Escala Breve de Funcionamiento Social. RESULTADOS: las relaciones entre el estigma personal y las variables sociodemográficas y psicosociales resultaron escasamente significativas. Sin embargo, las variables clínicas correlacionaron significativamente con diferentes facetas del estigma personal. Las correlaciones de las subescalas de estigma personal fueron entre estigma experimentado, estigma anticipado y autoestigma entre sí. El 29,5% de la variación de la subescala "trato injusto" se explicó por la edad de inicio y el nivel de depresión. El 20,1% de la variación de la subescala "autolimitación" se explicó por el nivel de depresión y el género. El 27,3% de la subescala "superación del estigma" se explica por el nivel de depresión y los síntomas psicóticos positivos y negativos. El 35,8% de la variación de la escala de autoestigma se explicó por el nivel de depresión. CONCLUSIONES: Abordar el estigma dentro del tratamiento parece de crucial importancia ya que todas las facetas del estigma están altamente relacionadas con las dimensiones clínicas, especialmente la depresión. Por lo tanto, incluir estrategias para reducir el estigma en los programas de atención puede ayudar a los pacientes con esquizofrenia a una mejor adaptación funcional y proceso evolutivo


BACKGROUND: Studies suggest that people with a diagnosis of schizophrenia are one of the most stigmatized groups in society. AIM: To comprehensively analyze personal stigma in patients diagnosed with schizophrenia. METHOD: Data were obtained from 89 patients. Patients were evaluated with the following scales: a sociodemographic and clinical questionnaire, the Discrimination and Stigma Scale, the Self-perception of Stigma Questionnaire for People with Schizophrenia, the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Global Assessment of Functioning Scale, and the Brief Social Functioning Scale. RESULTS: Relations between personal stigma and socio-demographic and psychosocial variables were poor. However, clinical variables correlated with different facets of personal stigma. Personal stigma subscales ́ correlations were between experienced stigma, anticipated stigma, and self-stigma to each other. 29.5% of the experienced stigma subscale variance was explained by age of onset and level of depression. 20.1% of the anticipated stigma subscale variance was explained by level of depression and gender. 27.3% of the overcoming stigma subscale variance was explained by level of depression and positive and negative psychotic symptoms. 35.8% of the self-stigma scale variance was explained by the level of depression


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Psicologia do Esquizofrênico , Estigma Social , Impacto Psicossocial , Fatores Socioeconômicos , Inquéritos e Questionários
19.
Epidemiol Psychiatr Sci ; 29: e137, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32539907

RESUMO

AIMS: Although shared decision-making (SDM) has the potential to improve health outcomes, psychiatrists often exclude patients with more severe mental illnesses or more acute conditions from participation in treatment decisions. This study examines whether SDM is facilitated by an approach which is specifically adapted to the needs of acutely ill patients (SDM-PLUS). METHODS: The study is a multi-centre, cluster-randomised, non-blinded, controlled trial of SDM-PLUS in 12 acute psychiatric wards of five psychiatric hospitals addressing inpatients with schizophrenia or schizoaffective disorder. All patients fulfilling the inclusion criteria were consecutively recruited for the trial at the time of their admission to the ward. Treatment teams of intervention wards were trained in the SDM-PLUS approach through participation in two half-day workshops. Patients on intervention wards received group training in SDM. Staff (and patients) of the control wards acted under 'treatment as usual' conditions. The primary outcome parameter was the patients' perceived involvement in decision-making at 3 weeks after study enrolment, analysed using a random-effects linear regression model. RESULTS: In total, 161 participants each were recruited in the intervention and control group. SDM-PLUS led to higher perceived involvement in decision-making (primary outcome, analysed patients n = 257, mean group difference 16.5, 95% CI 9.0-24.0, p = 0.002, adjusted for baseline differences: ß 17.3, 95% CI 10.8-23.6, p = 0.0004). In addition, intervention group patients exhibited better therapeutic alliance, treatment satisfaction and self-rated medication compliance during inpatient stay. There were, however, no significant improvements in adherence and rehospitalisation rates in the 6- and 12-month follow-up. CONCLUSIONS: Despite limitations in patient recruitment, the SDM-PLUS trial has shown that the adoption of behavioural approaches (e.g. motivational interviewing) for SDM may yield a successful application to mental health. The authors recommend strategies to ensure effects are not lost at the interface between in- and outpatient treatment.Trial registration: The trial was registered at Deutsches Register Klinischer Studien (DRKS00010880).


Assuntos
Tomada de Decisões , Pacientes Internados/psicologia , Participação do Paciente , Esquizofrenia/terapia , Adulto , Comunicação , Feminino , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Unidade Hospitalar de Psiquiatria , Psicologia do Esquizofrênico , Adulto Jovem
20.
Arch Ital Biol ; 158(1): 3-16, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32575143

RESUMO

Imitation is a basic human ability, present early in life. Previous studies on control subjects and callosotomized patients showed that imitation occurred mainly in mirror-mode in both groups (60% controls, 66% patients) when they imitate without instructions (free sessions). In contrast, when asked to use the same or opposite limb as the model (driven sessions), controls used anatomical mode (93%), callosotomized patients mainly mirror strategy (61%). It has been suggested that callosotomized subjects prefer the mirror mode because of an impaired capacity for mental rotation, likely due to the lack of the corpus callosum (CC). The present research investigated the imitation strategies used by schizophrenic patients, who also could present anomaly in the interhemispheric connections. Fifteen hospitalized patients with diagnosis of schizophrenia participated in the study. They were asked to imitate upper limb intransitive meaningful and meaningless gestures performed by a model in a video. The results were compared with those from 20 healthy individuals. In driven imitation, controls answered in anatomical mode (95% of the responses), versus 63% of patients' responses. In free imitation sessions the answers in anatomical mode decreased to 39% in control subjects and to 46% in schizophrenic patients. In both driven and free imitation, the differences between the two proportions, conditioned to Diagnosis, resulted significantly different. The present data, in line with previous studies on psychotic and neurological patients showing impairments on imitation, suggest that the neural circuitry leading patients to perform differently from controls likely relates with the functional efficiency of the CC.


Assuntos
Comportamento Imitativo , Esquizofrenia , Psicologia do Esquizofrênico , Corpo Caloso , Emoções , Gestos , Humanos
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