Luka Lucić

A new Integrated Negative Symptom structure of the Positive and Negative Syndrome Scale (PANSS) in schizophrenia using item response analysis

BACKGROUND Debate persists with regard to how best to categorize the syndromal dimension of negative symptoms in schizophrenia. The aim was to first review published Principle Components Analysis (PCA) of the PANSS, and extract items most frequently included in the negative domain, and secondly, to examine the quality of items using Item Response Theory (IRT) to select items that best represent a measurable dimension (or dimensions) of negative symptoms. METHODS First, 22 factor analyses and PCA met were included. Second, using a large dataset (n=7187) of participants in clinical trials with chronic schizophrenia, we extracted items loading on one or more PCA. Third, items not loading with a value of ≥ 0.5, or loading on more than one component with values of ≥ 0.5 were discarded. Fourth, resulting items were included in a non-parametric IRT and retained based on Option Characteristic Curves (OCCs) and Item Characteristic Curves (ICCs). RESULTS 15 items loaded on a negative domain in at least one study, with Emotional Withdrawal loading on all studies. Non-parametric IRT retained nine items as an Integrated Negative Factor: Emotional Withdrawal, Blunted Affect, Passive/Apathetic Social Withdrawal, Poor Rapport, Lack of Spontaneity/Conversation Flow, Active Social Avoidance, Disturbance of Volition, Stereotyped Thinking and Difficulty in Abstract Thinking. CONCLUSIONS This is the first study to use a psychometric IRT process to arrive at a set of negative symptom items. Future steps will include further examination of these nine items in terms of their stability, sensitivity to change, and correlations with functional and cognitive outcomes.

A rasch model to test the cross-cultural validity in the positive and negative syndrome scale (PANSS) across six geo-cultural groups

BackgroundThe objective of this study was to examine the cross-cultural differences of the PANSS across six geo-cultural regions. The specific aims are (1) to examine measurement properties of the PANSS; and (2) to examine how each of the 30 items function across geo-cultural regions.MethodsData was obtained for 1,169 raters from 6 different regions: Eastern Asia (n = 202), India (n = 185), Northern Europe (n = 126), Russia & Ukraine (n = 197), Southern Europe (n = 162), United States (n = 297). A principle components analysis assessed unidimensionality of the subscales. Rasch rating scale analysis examined cross-cultural differences among each item of the PANSS.ResultsLower item values reflects items in which raters often showed less variation in the scores; higher item values reflects items with more variation in the scores. Positive Subscale: Most regions found item P5 (Excitement) to be the most difficult item to score. Items varied in severity from −0.93 [item P6. Suspiciousness/persecution (USA) to 0.69 item P4. Excitement (Eastern Asia)]. Item P3 (Hallucinatory Behavior) was the easiest item to score for all geographical regions. Negative Subscale: The most difficult item to score for all regions is N7 (Stereotyped Thinking) with India showing the most difficulty Δ = 0.69, and Northern Europe and the United States showing the least difficulty Δ = 0.21, each. The second most difficult item for raters to score was N1 (Blunted Affect) for most countries including Southern Europe (Δ = 0.30), Eastern Asia (Δ = 0.28), Russia & Ukraine (Δ = 0.22) and India (Δ = 0.10). General Psychopathology: The most difficult item for raters to score for all regions is G4 (Tension) with difficulty levels ranging from Δ = 1.38 (India) to Δ = 0.72.ConclusionsThere were significant differences in response to a number of items on the PANSS, possibly caused by a lack of equivalence between the original and translated versions, cultural differences among interpretation of items or scoring parameters. Knowing which items are problematic for various cultures can help guide PANSS training and make training specialized for specific geographical regions.

Narrative Approaches to Conflict Resolution Across Technologically Mediated Landscapes

Young migrants across the globe increasingly interact and socialize with culturally diverse others across technologically mediated spaces. Bicultural and transnational development are becoming norms for contemporary youth as new media technology allows them to engage in interactions with diverse others across multiple cultural landscapes. What cultural tools do young migrants use to resolve conflicts with diverse peers across technologically mediated interpersonal interactions? To answer this question 44 individuals ages 15-20 participated in a quasi-experimental workshop engaging them in the process of sense-making. During the workshop participants wrote projective narratives in response to a vignette depicting text-massage mediated interaction embedded among monocultural and bicultural groups of peers. Quantitative and qualitative data analyses focus on physical, psychological and communicative conflict resolution strategies used in narrative construction. The results indicate that immigrant youth are able to employ and coordinate varied strategies when approaching conflict resolution across culturally diverse landscapes of social interactions.

Developmental Affordances of War-Torn Landscapes: Growing up in Sarajevo under Siege

Young people growing up in war zones experience significant changes of their physical and social environments caused by urban destruction. Employing the methodology of narrative inquiry, this work theoretically explores environmental and spatial affordances enabling sociocognitive development among young people growing up during the 4-year military siege of Sarajevo. The theoretical analysis focuses on two environmental contexts - war school and the Sarajevo war tunnel - and examines how affordances of physical environments, symbolically enacted in language, scaffold developmental activities during this highly specific wartime period. The developmental meaning of environmental affordances comes to life in contemporary narratives written by 16 adults who as young people attended war schools or worked in the Sarajevo war tunnel. Theoretical foundations of sociocultural and ecological psychology are employed to illuminate how environmental affordances contributed to the development of psychological functions well suited to everyday life in circumstances of war and urban destruction.

Changing landscapes, changing narratives: socio-cultural approach for teaching global migrants

Abstract Given the proliferation of new media technologies today’s immigrant children and youth are experiencing the effects of time–space compression in the domain of interpersonal interactions. Increasingly, they are able to simultaneously engage in developmental activities across their native and host societies. If migration is no longer a one-way binary choice, but rather a culturally dialectical process involving fluid articulation of consciousness and identity across multiple cultural landscapes, how can we structure teaching and learning to support cognitive development of immigrant children and youth as they gradually assume the responsibilities of adulthood? This work builds on socio-cultural theory in order to describe sense-making, a psychological process situated in interaction with extant social, cultural and physical environments, which employs language actively woven into a narrative as a tool for organising consciousness and perception. Practical recommendations stemming from this theoretical framework are explored in order to enable the tools for curriculum design that support bicultural and transnational developmental orientations.

Cultural-Existential Psychology: The Role of Culture in Suffering and ThreatCultural-Existential Psychology: The Role of Culture in Suffering and Threat, by SullivanDaniel. New York: Cambridge University Press, 2016. 295 pp.

The standard logic of contemporary psychological research seeks correlational or causational explanations of phenomena, often making the ceteris paribus assumption—that, all other things being equal, the relationships identified in a given study will hold generally. To understand how such paradigmatic relations translate into the laws governing psychological life, phenomena are isolated for study in the laboratory or under other forms of artificial conditions. Generally, this is done to specifically control for the situated messiness of human life that stands in stark contrast to the value-free idealist search for the underlying causal laws of human behavior. However theoretically desirable, the socio-cultural dynamics of race, gender, religious beliefs, immigration status, language, or class can never be fully controlled for within a traditional experimental design. As years of research in cultural psychology emphasize (Bruner 1962; Luria 1976; Vygotsky 1978; Nelson 1996), people cannot be randomly assigned to the shared cultural discourses that so utterly permeate our reality and contribute to the ways in which we make sense and make meaning of our lives. Instead—as psychologists working from the epistemological standpoint beyond the cultural turn are increasingly emphasizing— it is through active interactions with situated cultural tools that our capacity for symbolic consciousness emerges and develops. In other words, as humans we use tools that develop from a culture, such as language and narrative, to mediate our social environments (Vygotsky 1978; Scribner 1985; Nelson 1996). Because each of our lives is situated within a culture, neighborhood, class, and language group, the symbolic tools that are made available to us based on membership within these communities of minds have a pervasive effect on the totality of our experienced reality. Cultural-Existential Psychology: The Role of Culture in Suffering and Threat, by Daniel Sullivan, shows that it is precisely these other things—the often overlooked or disregarded cultural variables—that enable us to study how people across culturally diverse settings react differentially to existential threat and experience suffering. Rooted in social psychology, this sophisticated, at times theoretically brilliant, work provides a comprehensive, interdisciplinary framework for synthesizing and extending the theoretical and empirical literature relevant to human psychological processes in times of dire straits. Drawing on research from cultural and experimental existential psychology, the perspective advanced in this book aims to show how people rely on culturally inscribed pathways when dealing with threatening experiences. The label ‘‘existential’’ is used to imply threats involving awareness of one’s potential nonbeing, as in a situation of environmental disaster, terminal disease, or war. Perhaps more significantly, as Sullivan points out, such events are often experienced as an attack on an individual’s socio-culturally shared symbolic structure and meaning system. While the text is rewarding in its interdisciplinary orientation, reading Sullivan’s book is at times a difficult and demanding undertaking. To set the stage on which the new theoretical perspective of cultural-existential psychology can emerge, the first part of the book draws from the extensive body of literature on existentialism that has emerged across philosophy and the social sciences in the past 200 years. In the latter part of the book, Sullivan argues that culture provides psychological protection against existential threat and presents research with a Mennonite community in rural Kansas to support this claim. While reading Sullivan’s careful analysis on the role of cultural narratives in the aftermath of threat experiences gives us reason to wish this part of the book was longer, his enthusiastic foray into the new theoretical framework of cultural-existential psychology comes with a set of problems. Like many 632 Reviews

110.00 cloth. ISBN: 9781107096868.

Treatment of patients with schizophrenia can be improved by precise administration of rating scales. The Positive and Negative Syndrome Scale (PANSS) is a commonly used tool to assess symptoms of schizophrenia. In order to develop a participatory learning program that aims to enhance raters training and increase inter-rater reliability we trained five actors to serve as standardized patients (SP). A training program for SPs was constructed using a narrative analysis scheme in the following manner: 1) Seven transcripts of SCI-PANSS interviews were analyzed and subdivided into thematic chapters including: symptom frequency, intensity, complexity, interference and impairment; 2) Script/story analysis of transcribed interviews were conducted where we identified scripted elements common among all seven interviews and storied elements that deviate from the script and have a function to individuate each of the interviews; 3) Linguistic markers (words, phrases, or discursive patterns indicative of symptoms and their severity) that are often seen as hallmarks of aetiology of schizophrenia were identified; 4) Symptoms were divided into two severity levels, moderate and severe, and three full SCI-PANSS interview scripts were built; 5) A workshop for five professional actors was conducted under the supervision of an expert PANSS interviewer. By studying the development of this program knowledge can be gained about a number of aspects related overall psycho-social functioning of individuals diagnosed with schizophrenia, such as the impact of semantic and discursive practices on interpersonal interactions and their further effect on the progress of the illness.

What Can We Learn About Psycho-social Functioning of Individuals Diagnosed with Schizophrenia From Standardized Patients?

Building upon Vygotsky’s (1934) theorizing regarding the disturbance of the function of concept formation in individual’s diagnosed with schizophrenia, we conducted a 12 week-long narrative study which explores social cognition, conceptualized along the lines of person-activity-context, in adults residing at a large psychiatric hospital in New York City. In order to explore the function of social cognition – operationalized in this study in terms of narrators’ use and integration of evaluative elements such as psychological states, causal relations, and conflict resolution strategies across various narrative dimensions – we asked the participants to narrate in response to prompts that direct their writing toward varied audiences. We hypothesized that narrative functions will be better integrated when participants are engaged in sense-making of a) fictional social contexts, followed by b) social contexts outside of the hospital and c) social context of other’s with significant power over their daily functioning within the hospital. Comparative data analyses of narratives (about conflict resolution inside and outside of the hospital, and letters written by patients to a doctor inside the hospital and a friend outside of the hospital) written by fifteen participants show a clear difference in the use of evaluative elements across social contexts b and c, in a direction opposite from our initial hypothesis. Specifically, data shows pronounced differences in narrative length, use of psychological states, conflict resolution strategies, use of causal connectors, and overall greater scrip complexity in narratives towards the social context of other’s with significant power than toward social context outside of the hospital.

Narrative Exploration of Social Cognition in Adults Hospitalized Due to Symptoms of Schizophrenia

Background: The growing rate of seniors in the San Francisco-Bay Area is projected to increase the number of people with dementia by 61% between 2000 and 2030. San Franciscans with dementia are more vulnerable than the general population of seniors in the US because they are more likely to be members of racial/ethnic minority groups, born in another country, speak languages other than English, live in poverty, or live alone. Support for dementia patients is often the responsibility of informal caregivers; however, caregiving is time consuming, difficult, and strains the ability to engage in activities that protect and preserve caregivers’ own health and security. Methods:Uniquely, San Francisco is the only city in the USwith a Strategic Plan for addressing dementia. Thus, the San Francisco Dementia Support Network a collaborative partnership between University of California, Alzheimer’s Association, and Kaiser Permanente is providing a threepronged approach to improve the self-efficacy, knowledge, and skills of caregivers during times of medical, functional, or caregiving crisis through education services and a full-time social worker, a Dementia Care Expert. The 6-month intervention aims to decrease preventable emergency room visits and/or hospitalizations and increase utilization of community-based services by caregivers. Effectiveness is measured through pre/post-test evaluations. Results: To date, 105 patient-caregiver dyads have been enrolled and post-test evaluations are on-going. Participant demographics are highly diverse. Among dementia patients: 86 are age 60+; 55 females; 41 and 40 cared for by their spouse or child, respectively; 39 White Non-Hispanic, 8 White Hispanic, 26 Asian, 17 African-American; and 21 Veterans. Among caregivers: 54 are age 60+; 70 females; 36 White Non-Hispanic, 8 White Hispanic, 30 Asian, 21 African-American; and 12 Veterans. Conclusions: The intervention periodwill conclude byMarch 2013, at which point, a comprehensive data analysis will be conducted. Additionally one outcome of the project has been amending the electronic health records at Kaiser San Francisco to include caregiver information in the patient’s Alzheimer’s disease care plan. Preliminary findings show an increase in caregiver efficacy and positive qualitative feedback from caregivers. Service utilization analysis is still pending, but these findings will be included in the presentation.