57 research outputs found
Association between oxytocin receptor gene polymorphisms and self-rated 'empathic concern' in schizophrenia
The nonapeptide oxytocin (OXT) and its receptor (OXTR) have been implicated in social cognition, empathy, emotion and stress regulation in humans. Previous studies reported associations between OXT and OXTR genetic polymorphisms and risk for disorders characterized by impaired socio-emotional functioning, such as schizophrenia and autism. Here we investigate the influence of two single nucleotide polymorphisms (SNPs) within the OXTR gene on a measure of socio-emotional functioning in schizophrenic patients. OXTR SNPs that were previously investigated in other studies were genotyped in 145 patients diagnosed with schizophrenia according to DSM-IV and 145 healthy controls matched for age and gender. The Interpersonal Reactivity Index (IRI) was used to assess cognitive ('perspective taking'), affective ('empathic concern') and self-related ('personal distress') dimensions of empathy. No group differences in genotype frequencies were observed. MANCOVA revealed a significant main (F [1,282] = 10.464; pGG) with 'empathic concern'. Within the schizophrenia group, linear regression analysis determined OXTR rs2254298 genotype, PANSS negative and general symptom score, and age of disease onset as being significantly associated with 'empathic concern'. OXTR rs2254298 significantly impacted PANSS general psychopathology scores. No associations were found for OXTR rs53576, IRI 'perspective taking' or 'personal distress' ratings. Our preliminary findings support hypotheses about an involvement of OXTR rs2254298 in emotional empathy in schizophrenic and healthy individuals, warranting independent replication
Can “Model Projects of Need-Adapted Care” Reduce Involuntary Hospital Treatment and the Use of Coercive Measures?
Intensive outpatient models of need-adapted psychiatric care have been shown
to reduce the length of hospital stays and to improve retention in care for
people with severe mental illnesses. In contrast, evidence regarding the
impact of such models on involuntary hospital treatment and other coercive
measures in inpatient settings is still sparse, although these represent
important indicators of the patients' wellbeing. In Germany, intensive models
of care still have not been routinely implemented, and their effectiveness
within the German psychiatric system is only studied in a few pioneering
regions. An innovative model of flexible, assertive, need-adapted care
established in Berlin, Germany, in 2014, treating unselected 14% of the
catchment area's patients, was evaluated on the basis of routine clinical
data. Records of n = 302 patients diagnosed with severe mental disorders, who
had been hospitalized at least once during a 4-year-observational period, were
analyzed in a retrospective individual mirror-image design, comparing the 2
years before and after inclusion in the model project regarding the time spent
in hospital, the number and duration of involuntary hospital treatments and
the use of direct coercive interventions like restraint or isolation. After
inclusion to the project, patients spent significantly less time in hospital.
Among patients treated on acute wards and patients with a diagnosis of
psychosis, the number of patients subjected to provisional detention due to
acute endangerment of self or others decreased significantly, as did the time
spent under involuntary hospital treatment. The number of patients subjected
to mechanical restraint, but not to isolation, on the ward decreased
significantly, while the total number of coercive interventions remained
unchanged. Findings suggest some potential of intensive models of need-adapted
care to reduce coercive interventions in psychiatry. However, results must be
substantiated by evidence from randomized-controlled trials and longer
observation periods
Traumatic Events, Social Adversity and Discrimination as Risk Factors for Psychosis - An Umbrella Review
Exposure to childhood trauma is a well-known risk factor for severe mental disorders including schizophrenia and other non-affective psychoses. Beyond childhood trauma, there is increasing evidence that bullying, social exclusion, and discrimination during adolescence and adulthood may increase the risk of developing a psychotic disorder, and that such forms of traumatization may also underlie the elevated psychosis risk among migrants or persons with a visible minority status. In this umbrella review, we systematically assess meta-analyses regarding trauma and social adversity. A systematic literature review yielded 11 meta-analyses that met inclusion criteria and could be summarized quantitatively with a random effect model. Furthermore, six meta-analyses were evaluated qualitatively. Heterogeneity and publication bias were apparent in several meta-analyses. We observed that most significant social risk factors for psychosis were vulnerability for racist discrimination [OR = 3.90 (3.25-4.70)], migration [OR = 2.22 (1.75-2.80)], and childhood adversities [OR = 2.81 (2.03-3.83)]. Furthermore, social factors increasing the risk for psychosis were variation/impairment of parental communication, aversive adult life events, bullying, and factors associated with social isolation and discrimination. In spite of these environmental risk factors, there is a lack of evidence regarding treatment of trauma and psychosis, although some psychotherapeutic and art therapy approaches appear to be promising. Beyond individual interventions, stigmatization, racism, and other forms of discrimination need to be targeted to increase solidarity and communal support
Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach
Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the 'levels of structural integration' of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 'levels of structural integration' axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person's actual reflexive and metacognitive capabilities. Psychotherapeutic procedures specific for psychoses may promote and challenge a patient's metacognitive capacities, but should equally take the need for maturing structural skills into account. Modern psychodynamic approaches to psychosis are shortly presented, providing concepts and techniques for the implicit regulation of interpersonal experience and aiming at structural integration in this patient group
Feasibility, Impact on Symptoms and Mentalising Capacity
This pilot study aimed to evaluate the feasibility of an assessor-blind,
randomised controlled trial of psychodynamic art therapy for the treatment of
patients with schizophrenia, and to generate preliminary data on the efficacy
of this intervention during acute psychotic episodes. Fifty-eight inpatients
with DSM-diagnoses of schizophrenia were randomised to either 12 twice-weekly
sessions of psychodynamic group art therapy plus treatment as usual or to
standard treatment alone. Primary outcome criteria were positive and negative
psychotic and depressive symptoms as well as global assessment of functioning.
Secondary outcomes were mentalising function, estimated with the Reading the
mind in the eyes test and the Levels of emotional awareness scale, self-
efficacy, locus of control, quality of life and satisfaction with care.
Assessments were made at baseline, at post-treatment and at 12 weeks' follow-
up. At 12 weeks, 55% of patients randomised to art therapy, and 66% of
patients receiving treatment as usual were examined. In the per-protocol
sample, art therapy was associated with a significantly greater mean reduction
of positive symptoms and improved psychosocial functioning at post-treatment
and follow-up, and with a greater mean reduction of negative symptoms at
follow-up compared to standard treatment. The significant reduction of
positive symptoms at post-treatment was maintained in an attempted intention-
to-treat analysis. There were no group differences regarding depressive
symptoms. Of secondary outcome parameters, patients in the art therapy group
showed a significant improvement in levels of emotional awareness, and
particularly in their ability to reflect about others' emotional mental
states. This is one of the first randomised controlled trials on psychodynamic
group art therapy for patients with acute psychotic episodes receiving
hospital treatment. Results prove the feasibility of trials on art therapy
during acute psychotic episodes and justify further research to substantiate
preliminary positive results regarding symptom reduction and the recovery of
mentalising function
Endogenous oxytocin response to film scenes of attachment and loss is pronounced in schizophrenia
Oxytocin (OXT) is critically involved in the regulation of attachment and interpersonal function. In this study, emotional childrens movies were used to stimulate OXT secretion in patients with schizophrenia and healthy controls (HCs). Furthermore, associations of OXT levels with measures of attachment style (Psychosis Attachment Measure), childhood adversity (Childhood Trauma Questionnaire) and symptom severity [Positive and Negative Syndrome Scale (PANSS)] were considered. In 35 patients with schizophrenia and 35 matched HCs, radioimmunoassay with sample extraction was used to determine OXT plasma levels before and after viewing of movie scenes portraying emotional bonding and loss and compared to a non-emotional condition. Statistical analysis indicated lower baseline OXT levels in female patients than in all other groups. OXT reactivity during emotional movies was significantly higher in patients when compared to HCs. OXT reactivity during the control movie related to PANSS `general psychopathology. No significant associations appeared between baseline or induced OXT levels and other PANSS subscales, attachment style or childhood adversity in patients. Our findings suggest differences of baseline OXT and a higher OXT reactivity toward strong emotional stimuli in patients with schizophrenia, suggesting a role of OXT as a gender- and context-dependent modulator of socio-emotional function
Peripheral oxytocin is inversely correlated with cognitive, but not emotional empathy in schizophrenia
Endogenous oxytocin has been associated with different aspects of social cognition in healthy subjects and patients with schizophrenia. In this pilot study, we investigated the relationship between plasma oxytocin and oxytocin level changes induced by empathy-eliciting, attachment-related movie scenes with correlates of cognitive and emotional empathy in patients and healthy controls. The Multifaceted Empathy Test (MET) and the Interpersonal Reactivity Index (IRI) were administered to patients with schizophrenia (N = 35, 12 females) and healthy controls (N = 35, 12 females) to estimate dimensions of cognitive and emotional empathy. Peripheral basal oxytocin concentrations and oxytocin responses to movie-based emotional stimuli were assessed using radioimmunoassay with sample extraction. In patients, induced oxytocin level changes were inversely correlated with MET cognitive empathy regarding negative emotional states. Controlling for non-social cognition and age revealed a significant negative association between basal oxytocin levels and MET cognitive empathy for positive emotions. In healthy subjects, oxytocin reactivity was inversely correlated with the IRI subscale "fantasy". Oxytocin was not related to any measure of emotional empathy. A hyper-reactive oxytocin system might be linked to impaired cognitive empathy as a part of a dysfunctional regulative circuit of attachment-related emotions and interpersonal stressors or threats by attribution of meaning. Healthy adults with a disposition to identify with fictional characters showed lower oxytocin reactivity, possibly indicating familiarity with movie-based stimuli. The oxytocinergic system may be involved in maladaptive coping mechanisms in the framework of impaired mentalizing and associated dysfunctional responses to interpersonal challenges in schizophrenia
Exploring Influences on Theory of Mind Impairment in Opioid Dependent Patients
Theory of mind (ToM) is an aspect of social cognition impaired in different addictive disorders, including opioid addiction. This study aimed at replicating ToM deficits in opioid dependent patients undergoing opioid maintenance treatment (OMT) and exploring the influence of substance use related variables, executive functions and childhood maltreatment on ToM in opioid dependent patients. 66 opioid dependent patients were tested using the Movie for Assessment of Social Cognition (MASC) and compared with the data of healthy controls. Furthermore, the opioid dependent patients underwent testing for executive functions and filled in the Childhood Trauma Questionnaire (CTQ). Performance on the MASC was significantly poorer in the opioid dependence group than in the control group, even when recent additional drug use and psychiatric comorbidities were controlled for. No correlations were found between ToM and substance use related factors. Aspects of ToM performance in opioid dependent patients correlated significantly with different EF domains. ToM correlated significantly with the CTQ scales for physical maltreatment. The results confirm impaired ToM in opioid dependent patients and highlight executive functions and childhood maltreatment as influential factors. The lack of associations between ToM and substance use related variables and the association with childhood maltreatment suggest that ToM impairments might be a risk factor predating substance abuse.Peer Reviewe
Structural impairment and conflict load as vulnerability factors for burnout – A cross-sectional study from the German working population
IntroductionIndividual vulnerability and resilience factors are increasingly studied in burnout research. This is especially true for clinical variables that translate directly into intervention programs from a psychodynamic perspective. For example, few studies have examined the relationship between structural impairment and the individual spectrum of motivational conflicts according to the Operationalized Psychodynamic Diagnosis system (OPD) in relation to burnout. To substantiate previous findings, we hypothesized that structural impairment as well as motivational conflicts are related to burnout, but that structural impairment explained additional variance and mediated a possible relationship between conflicts and burnout.MethodThe present cross-sectional study was carried out on a sample of the German working population (N = 545). Questionnaires were used to measure structural impairment (OPD-SQS), the conflict-modes along with the category K0 (OPD-CQ), as well as burnout (BOSS-I/-II).ResultsStructural impairment, a number of conflict modes, and burnout were significantly associated. Moreover, structural impairment explained additional variance in burnout. The requirements for the conflict-specific mediation models were given for 9 of the 12 OPD conflict modes. In these models the impact of the conflict modes on burnout was mediated by structural impairment.DiscussionThe current study broadens the comprehension of the relations between structural impairment, the conflict modes and burnout. In addition it higlights the role of structural impairment in predicting burnout risk and possible prevention approaches
Linguistic findings in persons with schizophrenia—a review of the current literature
IntroductionAlterations of verbalized thought occur frequently in psychotic disorders. We characterize linguistic findings in individuals with schizophrenia based on the current literature, including findings relevant for differential and early diagnosis.MethodsReview of literature published via PubMed search between January 2010 and May 2022.ResultsA total of 143 articles were included. In persons with schizophrenia, language-related alterations can occur at all linguistic levels. Differentiating from findings in persons with affective disorders, typical symptoms in those with schizophrenia mainly include so-called “poverty of speech,” reduced word and sentence production, impaired processing of complex syntax, pragmatic language deficits as well as reduced semantic verbal fluency. At the at-risk state, “poverty of content,” pragmatic difficulties and reduced verbal fluency could be of predictive value.DiscussionThe current results support multilevel alterations of the language system in persons with schizophrenia. Creative expressions of psychotic experiences are frequently found but are not in the focus of this review. Clinical examinations of linguistic alterations can support differential diagnostics and early detection. Computational methods (Natural Language Processing) may improve the precision of corresponding diagnostics. The relations between language-related and other symptoms can improve diagnostics
- …