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Biomedical subjects

David Roe

Publications and source records attributed to David Roe.

At least 19 recordsLinked to original sources
PubMed2006

Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders.

Research has paradoxically linked awareness of illness to both better function outcomes and lesser hope and self-esteem. One possible explanation for these findings is that acceptance of having schizophrenia may impact outcomes differently depending on the meanings the person attaches to this acceptance, particularly whether he or she accepts stigmatizing beliefs about mental illness. To explore this possibility we performed a cluster analysis of 75 persons with schizophrenia spectrum disorders based on single measures of insight using the Positive and Negative Syndrome Scale, internalized stigma using the Internalized Stigma of Mental Illness Scale, and compared groups on concurrent assessments of hope and self-esteem. Three groups were produced by the cluster analyses: low in sight/mild stigma (n = 23), high insight/minimal stigma (n = 25), and high insight/moderate stigma (n = 27). As predicted, analysis of variance-comparing groups revealed that the high insight/moderate stigma group had significantly the lowest levels of hope on the Beck Hopelessness Scale and self-esteem using the Multidimensional Self-esteem Inventory. As predicted, the high insight/minimal stigma group also had significantly less impaired social function than the other groups. Implications for assisting persons to come to cope with awareness of illness and stigma are discussed.

Adaptation, Psychological↗
PubMed2006

Insight into psychosis and quality of life.

BACKGROUND: Insight into having a psychotic disorder is often considered to be a positive characteristic that improves quality of life. However, the evidence regarding this controversy is mixed. The present study examined the relation between insight and quality of life. METHOD: One hundred thirty-one participants with a psychotic disorder (103 with schizophrenia, 28 with schizoaffective disorder) underwent an assessment of insight, psychotic symptoms, and quality of life. The relation between insight and quality of life was assessed using regression analyses. RESULTS: Contrary to our hypothesis, better insight into having a psychotic disorder was related to reduced emotional well-being (beta = .23, P < .01), lower vocational status (beta = .31, P < .01), and less economic satisfaction (beta = .27, P < .01). Insight into the need for taking medication was positively correlated with higher emotional well-being (beta = -.18, P < .05). No relation was found between insight and psychotic symptoms. DISCUSSION: In light of our findings, the potential importance of combining insight with mechanisms for coping is discussed.

Adaptation, Psychological↗
PubMed2006

Associations of symptoms, psychosocial function and hope with qualities of self-experience in schizophrenia: comparisons of objective and subjective indicators of health.

While changes in self-experience have been suggested to be an important element of recovery from severe mental illness, little is known about how qualities of self-experience are linked with other indicators of health including objective measures such as symptoms profiles and subjective measures such as hope. To examine these issues the narratives of self and illness of 65 persons with schizophrenia spectrum disorder were obtained prior to entry into rehabilitation and rated using the Scale to Assess Narrative Development (STAND). STAND scores were then compared with concurrent assessments of hope assessed with the Beck Hopelessness Scale (BHS), psychosocial function using the Quality of Life Scale (QOLS) and symptom profile defined categorically using the Positive and Negative Syndrome Scale (PANSS). Results suggest that higher ratings of the STAND were associated with greater expectations of perseverance on the BHS and higher levels of psychosocial function on the QOL. Lower symptom profiles were similarly linked with higher STAND scores. Results suggest qualities of self-experience expressed within personal narratives are linked to symptom profiles and subjective assessments of health. Theoretical and clinical implications are discussed.

Adult↗
PubMed2006

Leading a horse to water: an action perspective on mental health policy.

Following publication of several landmark policy documents beginning in 1999, there are unprecedented opportunities for reforming mental health care to meet the needs of persons with mental illness. In this article, the authors suggest that transforming mental health requires dramatic changes in theory as well as in policy and practice, offering action theory as a corrective for a clinical psychology that has yet to view people as active agents shaping their own lives. A participatory approach to policy development and adoption of an action-oriented model of clinical practice provide examples of the shift, which results from treating people to enhancing their access to opportunities and offering them the in vivo supports they need to pursue meaningful lives even while disabled.

Adult↗
PubMed2006

Personal and interpersonal perceived control and the quality of life of persons with severe mental illness.

Studies have been carried out to explore the impact of sense of control on the outcome of persons with severe mental illness (SMI). However, few studies have compared the differential effects of perceived personal control (control of the self) and perceived interpersonal control (the control of significant others). In the present study, we investigated the relations between perceived personal and perceived interpersonal control and different domains of quality of life (QOL) of persons with SMI. Measures of perceived personal and interpersonal control and QOL were administered to 145 participants with a diagnosis of SMI (schizophrenia, affective disorders, anxiety disorders, personality disorders). The results showed personal control to be positively related to various domains of QOL (beta = .28-.31, p < 0.001-0.01) while interpersonal control was negatively related to the physical domain of QOL (beta= -.20, p < 0.05). Theoretical, empirical, and clinical implications of the distinction between personal and interpersonal control for persons with SMI are discussed.

Adult↗
PubMed2006

Coping with psychosis: an integrative developmental framework.

One important way in which persons with severe mental illness, such as schizophrenia, can influence the recovery process is by coping with the profoundly negative effects of mental illness. Despite accumulating evidence on the active role of the person in his or her recovery, there remains much conceptual confusion regarding the nature and categorization of the concept of coping. The present article constructs a clinically useful framework of coping that describes parallel and consecutive types of coping processes by applying Schwarzer's proactive coping theory to severe mental illness. Four coping modes including reactive, anticipatory, preventive, and proactive are described, and the role of meaning making is elaborated on as an integrative framework. Future research can be directed at validating the presented model and investigating the relationship between these types of coping and other relevant dimensions such as symptoms, functioning, and recovery.

Adaptation, Psychological↗
PubMed2006

Clients' feelings during termination of psychodynamically oriented psychotherapy.

Although the termination stage of psychotherapy is known to evoke powerful feelings, it has rarely been the subject of systematic investigation, and its relation to other aspects of therapy has not been evaluated. In the present study, we explored clients' feelings during termination of psychodynamically oriented psychotherapy and examined how these feelings are related to satisfaction with psychotherapy. Eighty-four persons who had been seen in private-practice psychodynamically oriented psychotherapy were assessed using open-ended questions and rating scales focusing on their feelings during termination. Results of the current study indicate that clients experience a wide range of feelings, many positive, during the termination phase of therapy. Factors that contributed to positive feelings were the experience of termination as a practice of independence, a reflection of positive aspects of the therapeutic relationship, and positive gains experienced in therapy. Loss of a meaningful relationship was the most frequently mentioned factor contributing to negative feelings during termination. Longer treatment was related positively to positive feelings toward termination and satisfaction with termination. The importance of incorporating the positive feelings about termination into the ending phase of therapy and its management are discussed.

Adolescent↗
PubMed2005

Recovering from severe mental illness: mutual influences of self and illness.

A growing body of literature on the subjective experiences of people with severe mental illness (SMI) reveals the importance of the experience of self. The current study explored how the course of SMI is related to individuals' subjective experience of self. Bimonthly, comprehensive, semi-structured interviews with 43 people who had been discharged from psychiatric hospitalization were conducted over a 1-year period. Qualitative analysis of the data revealed mutual influences between the experience of self and illness over time. Conceptual and clinical implications of the relation between self and illness are discussed.

Adult↗
PubMed2005

The subjective experience of people with severe mental illness: a potentially crucial piece of the puzzle.

Over the last two decades there has been growing interest in the subjective experiences of persons with severe mental illness (SMI). Despite this interest, little research has been carried out to understand whether and how such experiences are related to the course of SMI. In addition, few psychotherapeutic and rehabilitation interventions have been developed especially for persons with SMI that seriously take these persons' subjective experiences into account. In the present paper we discuss why the use and investigation of the subjective experience of people with SMI has been neglected, and we point out the potential importance of this experience. We then review the growing literature that focuses on the subjective experience of (1) the illness, (2) the self, and (3) the self as influenced by the social context of persons with SMI. Finally, the implications of this review for rehabilitation, recovery and research are discussed.

Attitude to Health↗
PubMed2005

Ethical dilemmas in psychotherapy: comparison between patients, therapists and laypersons.

BACKGROUND: The attitudes of patients towards ethical dilemmas in psychotherapy have been reported in only a few studies. AIMS OF THE STUDY: We investigated whether the attitudes of patients undergoing psychotherapy to confidentiality and boundaries are different from those of therapists and laypersons. METHODS: Clinical vignettes describing ethical dilemmas of confidentiality and boundaries were presented to 103 patients undergoing psychotherapy (patient group), 93 psychotherapists of different professional backgrounds (professional group), and 55 staff and students from the fields of law and the humanities (lay group). Patients were asked how they think therapists should act in the situations presented and therapists were asked how they should behave in such situations. RESULTS: In general, the patient group showed a greater tendency to view their therapists as breaching confidentiality than the professional and lay groups. Regarding boundaries, the majority of psychotherapists were against initiating any sexual relationship with current patients, former patients, students or supervisees, whereas both patients and laypersons showed a less stringent attitude; these differences were statistically significant. The vast majority of therapists (96.7%) disapproved of accepting money in advance compared to only 31.1% in the patients group and 54.4% of the lay group. Analysis of the patients group by gender did not reveal any significant relationships. CONCLUSIONS: (1) Patients have different ethical codes from therapists and laypersons regarding the issues of confidentiality. (2) Patients and lay persons are less strict than therapists regarding issues of boundaries.

Adult↗
PubMed2004

Persons with psychosis as active agents interacting with their disorder.

The current study focuses on the various strategies employed by individuals coping with psychiatric disorders. Data was gathered as part of the Yale Longitudinal Study; participants were 43 males and females--men and women with psychotic symptoms who were diagnosed with either schizophrenia, schizoaffective disorder, or major affective disorder with psychotic features. Participants were first assessed during hospitalization and completed bi-monthly follow-up interviews over the course of a year. Using qualitative research methods, each participant was interviewed using a semistructured interview that assessed the course of the disorder and change processes, focusing on each person's experiences of coping with a mental illness. In employing qualitative research methods the data obtained was distinctive in that it was suggested by the participants themselves, rather than being limited to predetermined categories. Results revealed a number of common coping strategies employed by individuals with a mental illness. These included: regulating activity, involvement and external stimuli; controlling symptoms; determination and hope; and the instigation of a change in attitude. The implications of these results are discussed for further research and for developing more effective treatment interventions for people with psychiatric disorders.

Adaptation, Psychological↗
PubMed2004

The emerging self in conceptualizing and treating mental illness.

1. The course of severe mental illnesses is more heterogeneous than previously thought and is influenced by many complex, interacting factors. 2. The experience of self and capacity to cope of people with mental illnesses contribute to the recovery process. 3. Changes in traditional treatment models and a focus on broader societal interventions are needed to facilitate recovery. 4. Psychiatric nurses play an important role in these new developments as evident, for example, in the 3R Program (relapse, recovery, and rehabilitation).

Adaptation, Psychological↗
PubMed2004

Are psychotherapists consistent in their ethical attitude to patient confidentiality?

BACKGROUND: The issue of confidentiality often causes an ethical dilemma for the psychotherapist. AIMS OF THE STUDY: We investigated if therapists are consistent in their attitude to confidentiality or judge each case on its own merit. METHODS: A questionnaire consisting of a series of clinical vignettes representing different ethical dilemmas in confidentiality in psychotherapy was completed by 93 therapists of different professional backgrounds and by a control group of 55 students from the fields of law and the humanities. RESULTS: Subjects in both groups were inconsistent in their attitude to confidentiality in two-thirds of cases, and most of the participants based their decisions on the particular history and circumstances of each case. CONCLUSION: The rules guiding psychotherapists for the disclosure of confidential information are unclear. These findings failed to pinpoint a common denominator to explain the manner in which professionals handle information that may demand a break of confidentiality.

Attitude of Health Personnel↗
PubMed2004

Personality disorders as grounds for reduced sentence in murder cases.

Clause 300 A (A) of the Israel penal code stipulates that severe mental disorder may serve as grounds for reduced sentence in cases of murder. There is an unresolved debate in the forensic psychiatric field whether severe personality disorders are included in this category. We present a set of criteria for applying this clause to offenders with personality disorder and demonstrate through three cases how these criteria can be used. All three cases had the following basic characteristics: A. Established diagnosis of severe personality disorder on the basis of historical data from multiple sources and in accordance with the evidence presented to the court. B. Presentation of a coherent description of the content of the murder as it directly affected the offender's severe impairment, with a strong link between the pathology and the offender's reduced capacity to understand or avoid the act. C. Establishment of the significantly limiting impact of the personality disorder on the offender's capacity to avoid the act, as based on the evidence presented to the court. We conclude that guidelines for formulating the psychiatric assessment and court report are feasible and necessary in these cases. Further experience in this area is needed until definite conclusions can be reached. Further studies are needed to confirm the suitability of this method.

Adult↗
PubMed2003

Beyond coping with mental illness: toward personal growth.

This study focused on the active attempts of individuals with severe mental illness to make sense of their disorders and initiate processes of personal growth. The findings are based on bimonthly comprehensive assessments conducted over a 1-year period with 43 persons who were hospitalized for schizophrenia and related disorders. Results reveal that living with severe mental illness may also generate processes of growth and change. Clinical and theoretical implications of these results are discussed.

Adaptation, Psychological↗
PubMed2003

A prospective study on the relationship between self-esteem and functioning during the first year after being hospitalized for psychosis.

A recent body of literature on the subjective experience of severe mental illness has reported on the importance of a person's self-esteem. Using a longitudinal design, this study investigates the relationship between self-esteem and functioning during the first year after being hospitalized for psychosis. The findings are based on comprehensive assessments conducted over a 1-year period with 43 persons hospitalized for schizophrenia and related disorders. Results reveal that change in level of self-esteem is significantly related to outcome. These results emphasize the importance of helping patients sustain positive self-esteem in the midst of disorder and treatment.

Adult↗
PubMed2003

Different ways of being aware of a psychiatric disability: a multifunctional narrative approach to insight into mental disorder.

Many people with a psychiatric disability appear to exhibit varying degrees of lack of awareness of the mental disorder that is implied by their diagnosis. Furthermore, there is considerable controversy regarding the significance of being aware of and acknowledging a psychiatric disorder. Different responses to the issues underlying this controversy can be found in the professional and research literature. This article describes and compares some of these responses. On the basis of this description and comparison, a multifunctional narrative approach to insight into mental disorder is developed, and implications of this approach for psychiatric rehabilitation research and for psychiatric rehabilitation intervention are explored.

Attitude to Health↗