Are social phobia and paranoia related, and which comes first?

.001), also with a dose response, i.e. more PS symptoms yield more SPh symptoms. PS emerging after SPh was not significant. This study confirmed the association of SPh and PS in a general population. Possibly this is caused by shared underlying psychological and behavioural processes. There was some indication that paranoid ideation precedes the development of SPh, but this must be considered with caution. Clinical implications are discussed. Keywords: paranoid symptoms; social phobia; comorbidity; general population surve

Systematic monitoring of needs for care and global outcomes in patients with severe mental illness

<p>Abstract</p> <p>Background</p> <p>It was hypothesised that the introduction of tools that allow clinicians to assess patients' needs and to negotiate treatment (Cumulative Needs for Care Monitor; CNCM), would be associated with global outcome improvements in patients diagnosed with severe mental illness.</p> <p>Methods</p> <p>The CNCM was introduced in one region in South Limburg (the Netherlands) in 1998 (REGION-1998) and in the rest of South Limburg in 2004 (REGION-2004). By comparing these two regions, changes after the introduction of the CNCM could be assessed (between-region comparison). In addition, a pre-post within-patient comparison was conducted in both regions.</p> <p>Results</p> <p>The within-patient comparison revealed that global outcomes of psychopathology and impairment improved in the first 3-5 years after the introduction of the CNCM. The between-region comparison revealed an improvement in global psychopathology but not in global impairment in REGION-2004 after 2004, while there was no such improvement in REGION-1998.</p> <p>Conclusion</p> <p>Systematic clinical monitoring of individual severe mental illness patients, in combination with provision of feedback, is associated with global improvement in psychopathology. More research is needed to determine the degree to which this association reflects a causal effect.</p

Executive function does not predict coping with symptoms in stable patients with a diagnosis of schizophrenia

<p>Abstract</p> <p>Background</p> <p>Associations between coping with and control over psychotic symptoms were examined using the Maastricht Assessment of Coping Strategies-24, testing the hypothesis that the cognitive domain of executive functioning predicted quality and quantity of coping.</p> <p>Methods</p> <p>MACS-24 was administered to 32 individuals with a diagnosis of schizophrenia. For each of 24 symptoms, experience of distress, type of coping and the resulting degree of perceived control were assessed. Coping types were reduced to two contrasting coping categories: symptomatic coping (SC) and non-symptomatic coping (NSC; combining active problem solving, passive illness behaviour, active problem avoiding, and passive problem avoiding). Cognitive functioning was assessed using the GIT (Groninger Intelligence Test), the Zoo map (BADS: Behavioural Assessment of Dysexecutive function), Stroop-test and Trail making.</p> <p>Results</p> <p>Cognitive function was not associated with frequency of coping, nor did cognitive function differentially predict SC or NSC. Cognitive function similarly was not associated with symptom distress or level of perceived control over the symptom.</p> <p>Conclusion</p> <p>There was no evidence that cognitive function predicts quantity or quality of coping with symptoms in people with a diagnosis of schizophrenia. Variation in the realm of emotion regulation and social cognition may be more predictive of coping with psychotic symptoms.</p

Patient with a long history of disease in whom service dog contributed to recovery

We describe a patient who reached recovery, after purchasing a dog and training it into an assistance dog. The patient has a long lasting (over 30 years) history in mental health care and was diagnosed with autism spectrum disorder, posttraumatic stress disorder and borderline personality disorder. All these years the patient did not reach symptomatic improvement or personal or social recovery. The patient suffered from severe emotional instability, feeling misunderstood, sleeping disorder because of nightmares and traumatic re-experiences, feeling unsafe and externalisation. There were repeated conflicts and periodical rejection of caregivers. A range of interventions and support options were offered. Medication intake was considerable aiming for sedation and numbness. After a second opinion an assistance dog was suggested. Two years after the purchase of the dog, her mood had improved, anxiety decreased, she slept better and stopped all medication. She feeled safe. Conflicts with others were reduced, she had some social contacts and the intensity of care had been reduced considerably.</p

The importance of context: An ESM study in forensic psychiatry

Experience Sampling Method (ESM) is a structured diary technique assessing variations in thoughts, mood, and psychiatric symptoms in everyday life. Research has provided ample evidence for the efficacy of the use of ESM in general psychiatry but its use in forensic psychiatry has been limited. Twenty forensic psychiatric patients participated. The PsyMate™ Device emitted a signal 10 times a day on six consecutive days, at unpredictable moments. After each “beep,” the patients completed ESM forms assessing current context, thoughts, positive and negative affect, and psychotic experiences. Stress was measured using the average scores of the stress related items. Compliance rate was high (85% beeps responded). Activity stress was related to more negative affect, lower positive affect, and more psychotic symptoms. This finding was restricted to moments when a team member was present; not when patients were alone or with other patients. ESM can be useful in forensic psychiatry and give insights into the relationships between symptoms and mood in different contexts. In this study activity-related stress was contextualized. These findings can be used to personalize interventions

Behavioural sensitization to daily life stress in psychosis

Recent neurobiological models provide a possible mechanism of daily life stress directly affecting the intensity of psychotic experiences in vulnerable individuals. In order to validate such a mechanism, the impact of daily life stress on psychosis intensity was investigated in two groups at increased risk of onset (relatives) and relapse (patients) of psychosis.status: publishe

De dagelijkse praktijk van een FACT-team: Resultaten van een experience-samplingstudie

Achtergrond Flexible assertive community treatment(FACT)-teams zijn in Nederland wijd verspreid. Ondanks de aanwezigheid van een modelbeschrijving en modelgetrouwheidsschaal is onduidelijk wat FACT-medewerkers dagelijks doen. Doel Onderzoek naar de dagelijkse bezigheden van FACT-medewerkers op werkdagen in relatie tot de beoogde bezigheden vanuit het theoretische FACT-kader. Methode De metingen in dit onderzoek werden verricht met de experience-samplingmethode (ESM) bij alle werkzame medewerkers (n = 54) van vier FACT-teams van drie verschillende organisaties door gedurende één week meerdere momenten op iedere werkdag te beschrijven. Na analyse in SPSS gaven 936 vragenlijsten een beeld van de dagelijkse werkzaamheden van FACT-medewerkers. Resultaten Globaal genomen besteedden medewerkers 30% van hun tijd met de cliënt, 30% aan overleg (4% met netwerkpartners), 20% aan administratie en 20% aan reistijd en persoonlijke activiteiten (30-30-20-20). Conclusie De werkelijke tijd die door FACT-medewerkers wordt doorgebracht met cliënten komt niet overeen met de gestelde productienormen. Het contact met naasten en het formele en informele netwerk blijft ver achter bij de huidige wens tot meer netwerkgericht werken. De gevonden resultaten vragen zorgvuldige interpretatie om perverse prikkels te voorkomen. Het toepassen van ESM in FACT-teams lijkt kwaliteitsontwikkeling te kunnen ondersteunen

Daily practice of a FACT-team:Results of an experience sampling study

BACKGROUND: Flexible assertive community treatment (FACT) teams are widespread in the Netherlands. Despite the presence of a model description and model fidelity scale, it is unclear what FACT workers actually do daily.AIM: Examination of the daily activities of FACT workers on weekdays in relation to the intended activities from the theoretical FACT framework.METHOD: Repeated momentary activity assessments were made among all employed staff (n = 54) of four FACT teams from three different organizations using the experience sampling method (ESM) yielding multiple reports on each workday for one week. 936 reports were analyzed with SPSS, providing a picture of the daily activities of FACT workers.RESULTS: Overall, employees spent 30% of their time with clients, 30% in consultation (4% with network partners), 20% on administration and 20% in travel time and personal activities (30-30-20-20).CONCLUSION: The actual time spent by FACT workers with clients does not match the expected production standards. Contact with relatives and network partners lags far behind the desired figures required for modern network-oriented care. The ESM-based results are different from actual methodologies and require careful interpretation. Applying ESM in FACT teams promises to support a quality development dialogue.</p