Reawakening Reflective Capacity in the Psychotherapy of Schizophrenia: A Case Study

Disturbed sense of self has long been identified as a common experience among people suffering with schizophrenia. More recently, metacognitive deficits have been found to be a stable and independent feature of schizophrenia that contributes to disturbed self‐experience and impedes recovery. Individual psychotherapy designed to target poor metacognition has been shown to promote a more coherent sense of self and enhanced recovery in people with schizophrenia. We provide a report of a 2‐year individual psychotherapy with a patient suffering with chronic schizophrenia. Progress was assessed over the course of treatment using the Metacognition Assessment Scale and the Brief Psychiatric Rating Scale. The patient experienced improved metacognitive capacity and reduced symptom severity over the course of therapy. Implications for clinical practice are discussed.     

Integrative Psychotherapy for Schizophrenia: Its Potential for a Central Role in Recovery Oriented Treatment

Research has affirmed that recovery from serious mental illnesses (SMI), such as schizophrenia, is a common outcome and often involves subjective changes in the experience of self, one's identity, and one's sense of agency in the world. Although many different interventions have been developed and validated, efforts to consider how those interventions should be integrated to assist people to direct their own recovery have been limited. This article considers the 5 case reports of psychotherapy presented in this special issue that have sought to integrate scientifically valid approaches within a recovery frame work. Exploring shared themes, this article suggests that a common set of processes exists between these examples of integrative work. These include therapist acceptance of a vulnerable stance in the face of uncertainty, which rejects stigma and remains open to knowing the person. This ultimately allows the kinds of meaning to be made jointly between the therapist and client that promote recovery.     

住院康复精神分裂症社交能力不足者的集体行为治疗

目的 对24例住院康复精神分裂症社交能力不足者在药物剂量相对稳定情况下，通过集体行为心理治疗，增强社会交往的主动性，减少和缓解退缩行为。方法 社会交往能力不足的精神分裂症康复期患者6～9人为1小组，在心理治疗师引导下，以社交技能训练、角色扮演、情景模拟等技巧训练，进行12次集体心理治疗。结果 治疗前后SANS量表分下降，部分阴性症状缓解，以较为积极的态度及行为与人交往。结论 集体行为心理治疗在住院康复精神分裂症社交能力不足者中的应用对提高其自信心，改善社交不足，提高生活质量，减轻家属负担有重要作用。     

The ongoing rewriting of the therapeutic contract in Metacognitive Interpersonal Therapy for narcissistic personality disorder: The case of Mark

In order to effectively treat individuals suffering from Narcissistic Personality Disorder (NPD), it is crucial to establish therapeutic goals and identify tasks to achieve them. However, this is a challenging process with NPD patients because they often struggle to find meaningful goals beyond the pursuit of status. Moreover, in order to change Furthermore, to promote change, they must confront painful emotions such as shame, guilt, or fear, which they habitually try to avoid. Additionally, they face difficulties in forming a positive perception of their therapists and cooperating towards mutually agreed-upon goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed.     

The Role of Interpersonal Connection,Personal Narrative,and Metacognition in Integrative Psychotherapy for Schizophrenia: A Case Report

The recovery movement has not only challenged traditional pessimism regarding schizophrenia but also presented opportunities for the possibilities for psychotherapy for people with the disorder. Though in the past psychotherapy models were often pitted against one another, recently there have been emergent reports of a range of integrative models sharing an emphasis on recovery and a number of conceptual elements. These shared elements include attention to the importance of interpersonal processes, personal narrative, and metacognition, with interest in their role in not only the disorder but also the processes by which people pursue recovery. This article explores one application of this framework in the psychotherapy of a woman with prolonged experience of schizophrenia and significant functional impairments.     

Impairment of perceptual metacognitive accuracy and reduced prefrontal grey matter volume in first-episode psychosis

Introduction: Metacognition, or “thinking about thinking”, is a higher-order thought process that allows for the evaluation of perceptual processes for accuracy. Metacognitive accuracy is associated with the grey matter volume (GMV) in the prefrontal cortex (PFC), an area also impacted in schizophrenia. The present study set out to investigate whether deficits in metacognitive accuracy are present in the early stages of psychosis.

Methods: Metacognitive accuracy in first-episode psychosis (FEP) was assessed on a perceptual decision-making task and their performance compared to matched healthy control participants (N = 18). A novel signal detection theory approach was used to model metacognitive sensitivity independently from objective perceptual performance. A voxel-based morphometry investigation was also conducted on GMV.

Results: We found that the FEP group demonstrated significantly worse metacognitive accuracy compared to controls (p?=?.039). Importantly, GMV deficits were also observed in the superior frontal gyrus. The findings suggest a specific deficit in this processing domain to exist at first episode; however, no relationship was found between GMV and metacognitive accuracy.

Conclusions: Our findings support the notion that an inability to accurately scrutinise perception may underpin functional deficits observed in later schizophrenia; however, the exact neural basis of metacognitive deficits in FEP remains elusive.     

精神分裂症患者杀亲行为的司法鉴定

目的探讨精神分裂症患者杀亲行为的特征及相关的精神病理学的差异。方法采用自编犯罪学调查表对61例精神分裂症患者以亲属为凶杀对象的凶杀案,与68例以非亲属为凶杀对象的凶杀案进行比较。结果①两组凶杀行为的主要原因均为幻觉、妄想,但对照组的关系妄想(χ2=4.04,P<0.05)及未经诊治问题突出(χ2=4.09,P<0.05);②在凶杀行为的决意实施方面,研究组计划、预谋明显少于对照组(χ2=5.27,P<0.05);③作案工具的选择方面,研究组绝大多数是随机取得(χ2=18.08,P<0.01);④受害人中研究组以配偶(28/61,45.90%)及母亲(24/61,38.24%)为多见,对照组以邻居为多见(27/68,39.71%)。结论精神分裂症杀亲行为的犯罪学特征更具有代表性。精神分裂症患者的密切接触者,是受害人中的重点预防对象,对于密切接触者的卫生宣教有利于凶杀预防。     

认知行为治疗对社区精神分裂症患者的疗效

目的:探讨认知行为治疗对社区精神分裂症患者的短期和长期疗效。方法:本研究为一项随机对照临床试验,纳入符合ICD-10精神分裂症诊断标准的患者32例,随机分成两组,分别接受常规治疗(TAU组,n=16)和常规治疗联合认知行为治疗(CBT组,n=16)。采用阳性与阴性症状量表(PANSS)和临床大体印象量表(CGI)于基线和治疗结束时分别对两组患者进行评定,并随访评估其半年和一年疗效。结果:112周、38周和64周时,CBT组PANSS总分显著低于TAU组(t=-2.174,-2.187,-3.256;P0.05);2在38周和64周时,CBT组阳性症状量表得分显著低于TAU组(t=-2.564,-2.146;P0.05);3在38周和64周时,CBT组一般精神病理症状量表分显著低于TAU组(P0.05);4CBT组的1年随访复发率显著低于TAU组(P0.025),而有效率显著高于TAU组(60.0%VS.20.0%,P=0.039)。结论:认知行为治疗可改善社区精神分裂症患者的症状及病情严重程度,尤其是阳性症状与焦虑抑郁等一般精神病理症状,降低复发率。     

门诊与住院精神分裂症患者首选药物调查

目的了解首次就诊患者抗精神药物应用现状。方法采用自行设计的调查表,顺序抽取我院每季度第一个月所有精神分裂症患者首次药物使用情况进行调查。结果①334例门诊精神病患者以使用非典型抗精神病药为主,奥氮平使用率最高(29.6%),其次为喹硫平(23.4%)、利培酮(23.1%)、阿立哌唑(14.4%);354例住院患者首选药物多为传统抗精神病药氟哌啶醇注射剂(28.8%),其他为非典型抗精神病药,依次为利培酮(28.5%)、喹硫平(17.8%)、奥氮平(8.8%)、阿立哌唑(6.5%);②住院患者合并使用抗精神病药者多于门诊患者,两者比较有非常显著的差异(χ2=144.91,P<0.01),使用最高的为非典型抗精神病药合并使用氟哌啶醇。门诊合并使用苯二氮卓类药物以及安坦者多于住院患者,两者比较均有非常显著的差异(2χ=6.91,P<0.01)、(2χ=19.5,P<0.01)。结论精神分裂症患者所接受的药物治疗比较规范和合理,非典型性抗精神病药已作为临床医生首选药物;部分医生对抗胆碱能药物和苯二氮卓类药物本身产生的不良反应给患者造成的危害认识不足。     

新森田疗法和康复疗法对精神分裂症康复治疗的对照研究

目的比较新森田疗法与康复疗法对精神分裂症康复治疗的效果。方法对符合入组标准的150例精神分裂症患者随机分为新森田疗法组和康复疗法组，治疗10周。于治疗前后分别用IPROS、BPRS、自知力评定进行自身和相互对照以评定疗效。结果两组治疗前后自身对照PPROS分量表及总分值、BPRS量表总分及因子分、自知力恢复情况均有显著差异（P均〈0.01）；相互对照：新森田疗法组康复效果更显著（P〈0.01），焦虑抑郁和缺乏活力因子分的减分率更明显（P〈0.01）。自知力恢复也较康复疗法组更显著（P〈0.01）。结论新森田疗法和康复疗法对协助临床改善精神分裂症的部分精神症状，自知力的恢复和社会功能的提高均有效，两者比较，新森田疗法的疗效更显著。     

Recovery style and stigma in psychosis: the healing power of integrating

Introduction. Persecutory delusions are a very common symptom in psychotic disorders and represent a considerable cost for both patients and for society. The way in which a person faces their psychotic disorder (i.e., recovery style) has impact on their recovery. The impact of coping style as a moderator in the course of their illness has not been studied sufficiently in persecutory delusions. In addition, internalised stigma is a common process in psychosis that not only might affect emotional distress, but might also shape recovery style. The goal of this study was to examine the moderator role of recovery style between internalised stigma and emotional distress in people with persecutory delusions. Methods. All 50 people with persecutory beliefs were assessed by the Recovery Style Questionnaire, the Beck Anxiety Inventory, Beck Depression Inventory, Second Edition, and Internalised Stigma of Mental Illness. Results. Moderation analysis showed that participants with a sealing-over recovery style had high levels of depression when they experienced internalised stigma and low levels of depression only when internalised stigma was low. However, participants with an integration recovery style presented similar levels of depression regardless of the level of their internalised stigma. Conclusions. Findings suggest the moderator role of recovery style between internalised stigma and depression in people with persecutory delusions.     

改良电痉挛治疗与686项目结合治疗精神分裂症阳性症状

目的探讨改良电痉挛治疗(MECT)与686项目结合治疗精神分裂症阳性症状的临床疗效。方法将299例686项目精神分裂症患者随机分为两组,分别给予MECT与利培酮治疗8周。采用简明精神病评定量表(BPRS)、阳性症状量表(SAPS)、不良反应量表(TESS)评定疗效及不良反应。结果实验组治疗总有效率为91.33%,利培酮组为62.41%,两组比较差异有统计学意义(χ2=4.62,P0.05)。实验组的锥体外系反应、窦速和停经泌乳等不良反应低于对照组(χ2=9.50,6.91,4.95;P0.05)。结论 MECT与686项目结合治疗精神分裂症阳性症状安全有效。