Liz Rietschel

The other side of “madness”: frequencies of positive and ambivalent attitudes towards prominent positive symptoms in psychosis

Background: Phenomenological descriptions of psychosis traditionally emphasize the subjective burden that psychosis inflicts on patients. However, a growing body of work suggests that in a subgroup of patients, psychotic symptoms are appraised as positive. The present study set out to explore the frequency of positive, negative and ambivalent attitudes towards positive symptoms. We were also interested in characterizing the phenomenological structure of positive symptoms. Method: Participants were recruited over the Internet via specialized psychosis forums. Among other questionnaires, participants completed the Community Assessment of Psychic Experiences (CAPE) scale. In addition, we administered a novel scale called Subjective Perception of Positive Symptoms (SUPPOSY) that assesses core positive symptoms along various dimensions (e.g. emotional appraisal, impact on daily life). Results: For all symptom clusters, the majority of participants expressed ambivalence. Psychotic symptoms were associated with both self-reported positive and negative emotions. Experiencing regret should positive symptoms disappear was associated with prior medication noncompliance. Discussion: The present study indicates that symptoms are neither regarded as an “emotional hell” nor as a “preferred reality”. Thus, for a symptom to become a target of treatment, various aspects of the symptom have to be carefully weighed.

The effect of practice on the recall of salient information in obsessive–compulsive disorder

Deficits in memory and cognitive inhibition have been proposed as underlying mechanisms of obsessive-compulsive disorder (OCD). To test this hypothesis, an emotional variant of the retrieval-induced forgetting (RIF) paradigm was constructed which investigates whether repeated retrieval of previously learned material (Rp+) leads to enhanced forgetting of related but nonretrieved material (Rp-) in comparison to unrelated material (NRp). Paradigm (involving OCD-relevant, neutral and negative material) was presented to 21 participants with OCD and 22 healthy controls. To compare personally relevant stimuli across groups, salience ratings of the material were included. RIF was not reduced in OCD per se. Tentative evidence was found for a weakened RIF effect for personally salient OCD-relevant material in OCD patients in comparison to healthy controls.

Are patients with obsessive–compulsive disorder generally more doubtful? Doubt is warranted!

A number of neuropsychological models implicate disinhibition and a lack of response confidence in the pathogenesis of obsessive-compulsive disorder (OCD). To provide a fair test of the inhibition and confidence account, a variant of the directed forgetting (DF) paradigm with OCD-related and unrelated conditions was administered in 30 OCD patients and 20 healthy controls. First, 16 words were presented which the participant was subsequently instructed to forget. Then, 16 words were presented that should be memorized. After a short interval, patients were shown the to-be-forgotten and the to-be-remembered items along with new items in random order. The subjects were instructed to recollect both the to-be-remembered and the to-be-forgotten items. The subject was asked to grade responses according to confidence. In accordance with prior findings from our group, patients did not differ from controls on overall recollection, response confidence, and the recollection of to-be-forgotten (allegedly inhibited) information. Our study cannot refute the claim that disinhibition plays a role in OCD in view of the vast array of paradigms tapping different aspects of inhibition. Still, we deem a psychological understanding more fruitful that looks at dysfunctional coping strategies and false beliefs as mechanisms for the persistence and pervasiveness of obsessive thoughts.

Früherkennung und integrierte Versorgung von Jugendlichen und jungen Erwachsenen mit schweren psychotischen Erkrankungen

This is a prospective 1-year follow-up study comparing a combined intervention consisting of multidimensional early detection strategies with age- and interdisciplinary integrated care (intervention group, n = 120) with standard care (historical control group, n = 105) in adolescents and young adults within the early phase of psychosis. Data at study entry indicate a high complexity and severity of illness. Primary outcome is the 6-month rate of combined symptomatic and functional remission at study endpoint.