Shyhrete Rexhaj

Sustained antipsychotic effect of metacognitive training in psychosis: A randomized-controlled study

Persistent psychotic symptoms represent a major challenge for psychiatric care. Basic research has shown that psychotic symptoms are associated with cognitive biases. Metacognitive training (MCT) aims at helping patients to become aware of these biases and to improve problem-solving. Fifty-two participants fulfilling diagnostic criteria of schizophrenia or schizoaffective disorders and persistent delusions and stabilized antipsychotic medication were enrolled in this study. Following baseline assessment patients were randomized either to treatment as usual (TAU) conditions or TAU+MCT. The intervention consisted of eight weekly 1-hour sessions (maximum: 8 hours). Participants were assessed at 8 weeks and 6-months later by blind assessors. Participants were assessed with the Psychotic Symptoms Rating Scales (PSYRATS) and the positive subscale of the PANSS. Between-group differences in post- and pre-test values were significant at a medium effect size in favor of the MCT for the PSYRATS delusion scale and the positive scale of the PANSS both at post and follow-up. The results of this study indicate that MCT training has a surplus antipsychotic effect for patients suffering from schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment and that the effect of the intervention persists for at least 6 months after the intervention.

Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy

BackgroundRecent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments.MethodsThis pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)—an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions.ResultsThirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention.DiscussionFindings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives.ConclusionsPEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study.Trial registration numberISRCTN registry ISRCTN74048461, registered 18 may 2015

Correlational study: illness representations and coping styles in caregivers for individuals with schizophrenia

BackgroundCaring for individuals with schizophrenia can create distress for caregivers which can, in turn, have a harmful impact on patient progress. There could be a better understanding of the connections between caregivers’ representations of schizophrenia and coping styles. This study aims at exploring those connections.MethodsThis correlational descriptive study was conducted with 92 caregivers of individuals suffering from schizophrenia. The participants completed three questionnaires translated and validated in French: (a) a socio-demographic questionnaire, (b) the Illness Perception Questionnaire for Schizophrenia and (c) the Family Coping Questionnaire.ResultsOur results show that illness representations are slightly correlated with coping styles. More specifically, emotional representations are correlated to an emotion-focused coping style centred on coercion, avoidance and resignation.ConclusionOur results are coherent with the Commonsense Model of Self-Regulation of Health and Illness and should enable to develop new interventions for caregivers.

French version validation of the psychotic symptom rating scales (PSYRATS) for outpatients with persistent psychotic symptoms

BackgroundMost scales that assess the presence and severity of psychotic symptoms often measure a broad range of experiences and behaviours, something that restricts the detailed measurement of specific symptoms such as delusions or hallucinations. The Psychotic Symptom Rating Scales (PSYRATS) is a clinical assessment tool that focuses on the detailed measurement of these core symptoms. The goal of this study was to examine the psychometric properties of the French version of the PSYRATS.MethodsA sample of 103 outpatients suffering from schizophrenia or schizoaffective disorders and presenting persistent psychotic symptoms over the previous three months was assessed using the PSYRATS. Seventy-five sample participants were also assessed with the Positive And Negative Syndrome Scale (PANSS).ResultsICCs were superior to .90 for all items of the PSYRATS. Factor analysis replicated the factorial structure of the original version of the delusions scale. Similar to previous replications, the factor structure of the hallucinations scale was partially replicated. Convergent validity indicated that some specific PSYRATS items do not correlate with the PANSS delusions or hallucinations. The distress items of the PSYRATS are negatively correlated with the grandiosity scale of the PANSS.ConclusionsThe results of this study are limited by the relatively small sample size as well as the selection of participants with persistent symptoms. The French version of the PSYRATS partially replicates previously published results. Differences in factor structure of the hallucinations scale might be explained by greater variability of its elements. The future development of the scale should take into account the presence of grandiosity in order to better capture details of the psychotic experience.

Safety-seeking behaviours and verbal auditory hallucinations in schizophrenia

Verbal auditory hallucinations can have a strong impact on the social and professional functioning of individuals diagnosed with schizophrenia. The safety-seeking behaviours used to reduce the threat associated with voices play a significant role in explaining the functional consequences of auditory hallucinations. Nevertheless, these safety-seeking behaviours have been little studied. Twenty-eight patients with schizophrenia and verbal auditory hallucinations were recruited for this study. Hallucinations were evaluated using the Psychotic Symptom Rating Scale and the Belief About Voice Questionnaire and safety behaviours using a modified version of the Safety Behaviour Questionnaire. Our results show that the vast majority of patients relies on safety behaviours to reduce the threat associated with voices. This reliance on safety behaviours is mostly explained by beliefs about origin of voices the omnipotence attributed to hallucinations and the behavioural and emotional reactions to the voices. Safety-seeking behaviours play an important role in maintaining dysfunctional beliefs with respect to voices. They should be better targeted within the cognitive and behavioural therapies for auditory hallucinations.

Projecting Oneself into the Future, an Intervention for Improving Pleasure in Patients with Anhedonia

In clinical practice, anhedonia and apathy are challenging symptoms of schizophrenia. Anhedonia in schizophrenia appears to be associated with impairment in anticipatory pleasure. However, the problem is complicated since comorbid depression occurs in 50 % of patients and the symptoms of the different disorders may overlap. This chapter presents an intervention to train anticipatory pleasure in patients with schizophrenia. This intervention has been evaluated in an exploratory pilot study. Results show that the patients improved on the anticipatory scale of the Temporal Experience of Pleasure Scale. Patients also increased their daily activities. The program is still being improved and should be tested in a controlled study.

Feasibility and Accessibility of a Tailored Intervention for Informal Caregivers of People with Severe Psychiatric Disorders: a Pilot Study

Objectives This study aimed to assess the acceptability and feasibility of a new tailored intervention for informal caregivers: the Ensemble (Together) program. Methods An open pre–post within-subject comparison pilot study was conducted. Twenty-one informal caregivers completed the five-session Ensemble program. Two measurement tools were used: The Brief Symptom Inventory (BSI) and the Life Orientation Scale (LOT-R). Results The results showed that informal caregivers were in need of individual support and were ready to participate in the Ensemble program independent of the patient’s diagnosis or stage of illness. The participants were very satisfied, and 95.4% completed the program. The preliminary results also showed that in five sessions, informal caregivers’ Global Severity Index measured by the BSI and their optimism about their future (measured by the LOT-R) were significantly improved. Conclusion This pilot study provided preliminary results concerning the feasibility and acceptability of the tailored Ensemble program and indicates the need for a randomized trial. The Ensemble program is appropriate for both the acute and chronic phases of disease. Individualized brief and useful interventions for informal caregivers may provide more positive outcomes in care.