Javier Saavedra

Incomprehensibility in the Narratives of Individuals With a Diagnosis of Schizophrenia

The fact that individuals with a diagnosis of schizophrenia have difficulties in terms of ordering and communicating their life stories is well known, and undoubtedly these dysfunctions are linked to the experience of alienation and isolation. In this article we contribute to the debate by studying life narratives of ten patients with a diagnosis of paranoid schizophrenia living in care homes in Andalusia, Spain. Patients were selected through meetings held with the directors of the care homes and data obtained from narrative, semistructured interviews. Thematic self-positioning and structure analysis identified four types of clearly distinctive narratives: delusive episodes with invasive voices, delusive episodes with no invasive voices, absence of delusive episodes or invasive voices and domination of self-position as patient, and complexity and articulation of self-positions.

Everyday life, culture, and recovery: carer experiences in care homes for individuals with severe mental illness.

Supported homes or Care Homes (CHs) have become in-services that play a fundamental role in social-health systems, particularly in mental health systems in Europe and the United States. They provide settings where residents’ day-to-day routines are supervised by in-house non-clinician professional carers. Ten semi-structured in-depth interviews were conducted by expert professional carers of persons with schizophrenia to explore interactions and activities between carers and users living in special “Care Homes”. Analysis focused primarily on the functions of everyday life and daily routines in the recovery process. Social positioning analysis was used to investigate meanings and subjective experiences of professionals. The analysis revealed the importance of personal interactions in daily routines for recovery. We identified two main concerns guiding professionals’ interactions with users: “Bring [users] to the here and now” and “give them the initiative to start actions”. We suggest that CHs promote the construction of privileged identity in western urban societies, forming part of the process towards recovery and better social integration.

Auditory Hallucinations as Social Self-Positions: A Theoretical Discussion from a Single-Case Study

This work uses social positioning analysis to investigate the phenomenon of the auditory verbal hallucination (AVH) in schizophrenia in order to describe its social and interactive nature. We focus in detail on a single-case study of a patient who verbalized her AVHs. We analyze 3 significant excerpts from an interview with a person with paranoid schizophrenia. This interview is part of a larger study conducted with 18 participants about life narrative construction in the sociocultural context of care homes. The interaction between the patient and her voices is examined closely to reveal the dynamic between interviewer, patient, and voices. The analysis differentiates the voice of the patient from that of the hallucination and reveals “social interaction” between this dyad and the interviewer. We discuss a possible social and interactive framework to understand the origin of AVHs and the self-construction process.

Cognitive and Social Functioning Correlates of Employment Among People with Severe Mental Illness

AbstractWe assess how social and cognitive functioning is associated to gaining employment for 213 people diagnosed with severe mental illness taking part in employment programs in Andalusia (Spain). We used the Repeatable Battery for the Assessment of Neuropsychological Status and the Social Functioning Scale and conducted two binary logistical regression analyses. Response variables were: having a job or not, in ordinary companies (OCs) and social enterprises, and working in an OC or not. There were two variables with significant adjusted odds ratios for having a job: “attention” and “Educational level”. There were five variables with significant odds ratios for having a job in an OC: “Sex”, “Educational level”, “Attention”, “Communication”, and “Independence-competence”. The study looks at the possible benefits of combining employment with support and social enterprises in employment programs for these people and underlines how both social and cognitive functioning are central to developing employment models.

Recovery and creative practices in people with severe mental illness: evaluating well-being and social inclusion

Abstract Purpose: This mixed (quantitative–qualitative) study evaluates the impact of an artistic workshop on a group of people with severe mental illness (SMI). This study focuses on the impact of creative practices on well-being and social inclusion outcomes. Method: After participating in a creative workshop, 31 people diagnosed with a SMI completed pre/post-intervention measures, namely, the Warwick-Edinburgh Mental Well-Being Scale and the Social Inclusion questionnaire. It was applied in two-way repeated measures analysis of variance. The statistic Wilcoxon and Kruskal–Wallis were applied for non-parametric data to measure pre/post-test effects and workshop experience effects, respectively. In addition to quantitative measures, one observer participated in each workshop that ran in parallel in order to deepen and triangulate quantitative outcomes. Results: The qualitative and quantitative results show that social inclusion improved in a significant way with an important size effect. Psychological wellbeing increased significantly with a low size effect. Conclusions: In accordance with these results, creative practices with people diagnosed with SMI are recommended. In order to increase the impact of these interventions, it is recommended to utilize public space away from clinical environments and to include people without SMI in creative activities together with SMI patients. Implications for Rehabilitation: Creative practices can significantly improve social inclusions and well-being in people with severe mental illness. Participating in creative workshops helps to elaborate personal meanings and promote recovery. Creative practices in mental health services can challenge professional roles and institutional practices. Participation of people with and without severe mental illness engaged together in artistic activities can decrease public stigma.

Riesgo de suicidio de hombres internos con condena en centros penitenciarios

AIMS Many studies have demonstrated that the risk of suicide in prison is higher than in the general population. This study has two aims. First, to explore the risk of suicide in men sentenced in Andalusian prisons. And second, to study the sociodemographic, criminal and, especially, psychopathological factors associated with this risk. METHODS An assessment was made of 472 sentenced inmates in two Andalusian prisons, and included a sociodemographic interview, the IPDE personality disorders questionnaire, the SCID-I diagnostic interview (DSMIV), and the Plutchick suicide risk questionnaire. The interviewers were experienced clinical psychologists with training in prison environments. Adjusted ORs were calculated using a logistic regression. RESULTS A risk of committing suicide was detected in 33.5% of the sample. The diagnoses (lifetime prevalence) of affective disorder (adjusted OR 3329), substance dependence disorders (adjusted OR 2733), personality disorders (adjusted OR 3115) and anxiety disorder (adjusted OR 1650), as well as a family psychiatric history (adjusted OR 1650), were the predictors that remained as risk factors after the regression analysis. No socio-demographic risk factor was significant in the regression analysis. CONCLUSIONS The psychopathological variables are essential and the most powerful factors to explain suicide risk in prisons. A correct and systematic diagnosis, and an appropriate treatment by mental health professionals during the imprisonment are essential to prevent the risk of suicide.

Impact of creative workshops for people with severe mental health problems: art as a means of recovery

Abstract Background: In line with recovery theories, psychosocial programmes for people diagnosed with severe mental illness (SMI) should focus more on well-being and social connectivity outcomes rather than clinical symptoms. This paper assesses the impact of creative workshops participation on the psychological well-being, social connectivity and subjective experience of people diagnosed with SMI. Method: After participating in a creative workshop in a museum, 19 people, including service users, keyworkers, the art facilitator and a psychologist were interviewed. Four observers participated in the workshop and provided information about the creative process by means of a discussion group. Data were analysed in accordance with thematic analysis methodology and triangulated in order to obtain reliability. Results: Five essential categories were identified: learning process, social connection, psychological well-being, institutional change and mutual recovery. Conclusions: Creative activities may cause a transformation of the image of dysfunction associated with mental illness as well as promoting health and recovery.

Function and meaning in religious delusions: a theoretical discussion from a case study

Religious delusion complexes (RDC) are phenomena sometimes experienced by people diagnosed with schizophrenia. The prevalence of this type of delusion varies according to area, culture and religious practice. Religious delusions have been associated to worse responses to treatment and worsening psychopathological conditions. However, religious beliefs and practices have also been described as factors of protection. Religious delusions are multidimensional phenomena within a continuous dimension with normality. This study uses a qualitative methodology to analyse an RDC in situ during a narrative interview with a person with paranoid schizophrenia. On the basis of this analysis we suggest that the functions and meanings of religious beliefs within the patients narrative and cultural context require analysis before they can be categorised as delusive.

Coping with Positive Symptoms and Disruptive Behaviors: Experiences of Professional Carers in Supported Houses for People Diagnosed with Schizophrenia

This article explores how professional carers cope with positive symptoms and disruptive behaviors of people diagnosed with schizophrenia who are living in care homes. Coping styles are seen as having a fundamental effect on stress levels and quality of life of both carers and users. The literature suggests that coping styles may influence symptom intensity of people diagnosed with schizophrenia. Until now, these coping strategies have not been analyzed in professional carers called monitors who work in care homes or supervised housing. In-depth interviews were conducted with ten expert carers working in care homes; they were asked about their experiences and interactions with users in a semistructured interview. The contents related to coping with symptoms and disruptive behaviors were selected on the basis of the grounded theory and studied from a qualitative perspective via an analysis of social positionings. Carers do not show any negative emotional burden when describing their experiences. Distraction coping strategies were used most to cope with positive symptoms. Neuromuscular relaxation and task coping strategies were also used. Interventions in the setting are considered essential for coping with violent behaviors. Carers use the majority of the strategies that are seen as most effective in the literature. The qualitative analysis of coping experiences is essential for the improvement and learning of the most effective caring behaviors.