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Biomedical subjects

Paul H Lysaker

Publications and source records attributed to Paul H Lysaker.

At least 19 recordsLinked to original sources
PubMed2007

The dialogical self in psychotherapy for persons with schizophrenia: a case study.

Schizophrenia often involves a profound experience of one's identity as diminished, which complicates adaptation to the demands of daily life. Within a backdrop of dialogical self-theory, we provide a report of an individual psychotherapy over the course of 4 years that assisted a patient suffering from schizophrenia to move from a state in which few aspects of self were available for internal or external conversation to one in which there was greater accessibility of multiple aspects of self, leading to richer dialogues, improved function, and a better quality of life. It is suggested a primary intervention of the therapist was continuously to offer the client a view of himself that invited him to experience himself in a plausible manner shared with and listened to by another.

Cognition Disorders↗
PubMed2006

Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months.

Research suggests stigma is a barrier to self-esteem and the attainment of resources in schizophrenia. Less clear is the association of stigma experiences with symptoms and social function both concurrently and prospectively. To assess this, symptoms were measured using the Positive and Negative Syndrome Scale, social function was measured using the Quality of Life Scale and stigma experience was assessed using the Internalized Stigma of Mental Illness Scale among 36 persons with schizophrenia at two points, 6 months apart. Correlations found stigma was associated with concurrent levels of positive and emotional discomfort symptoms and degree of social contact. When initial stigma levels were controlled for, stigma at 6 months was predicted by baseline levels of positive symptoms. Greater initial stigma predicted greater emotional discomfort at follow-up. Results suggest internalized stigma is linked with social function and symptoms. Positive symptoms may make some persons with schizophrenia more vulnerable to ongoing stigma experience.

Adult↗
PubMed2006

Cognitive insight and psychotic disorder: the impact of active delusions.

While several studies have determined the Beck Cognitive Insight Scale (BCIS; [Beck, A.T., Baruch, E., Balter, J.M., Steer, R.A., Warman, D.M., 2004. A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophr. Res. 68, 319-329] is a useful measure of cognitive insight, a number of questions have remained unanswered. While individuals with psychotic disorders have been shown to have impaired cognitive insight compared to a psychiatric comparison group, it has remained unclear how the cognitive insight of individuals with psychotic disorders compares to healthy individuals. Further, as previous studies have classified participants based on diagnostic classification, it has remained unknown if individuals with delusions and individuals with psychotic disorders without active delusions score differently on this measure. To examine these questions, we assessed the cognitive insight of healthy individuals and individuals with psychotic disorders, both with and without active delusions. Results indicated that individuals with psychotic disorders had impaired cognitive insight relative to healthy controls (p=.005), though individuals with active delusions and individuals with psychotic disorders without delusions had impairments in different domains. Individuals with delusions were overly confident in their own judgment relative to healthy controls and those without delusions (p=.011), though their self-reflectiveness was the same as normal controls. Individuals without delusions reported low self-reflectiveness relative to healthy controls and individuals with delusions (p=.004), though they were not overconfident in their judgment. These results are discussed in terms of existing research on cognitive insight, decision making, and psychosis.

Adult↗
PubMed2006

Jumping to conclusions and the continuum of delusional beliefs.

The present study examined the jumping to conclusions reasoning bias across the continuum of delusional ideation by investigating individuals with active delusions, delusion prone individuals, and non-delusion prone individuals. Neutral and highly self-referent probabilistic reasoning tasks were employed. Results indicated that individuals with delusions gathered significantly less information than delusion prone and non-delusion prone participants on both the neutral and self-referent tasks, (p<.001). Individuals with delusions made less accurate decisions than the delusion prone and non-delusion prone participants on both tasks (p<.001), yet were more confident about their decisions than were delusion prone and non-delusion prone participants on the self-referent task (p=.002). Those with delusions and those who were delusion prone reported higher confidence in their performance on the self-referent task than they did the neutral task (p=.02), indicating that high self-reference impacted information processing for individuals in both of these groups. The results are discussed in relation to previous research in the area of probabilistic reasoning and delusions.

Adult↗
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

Association of delusions and lack of cognitive flexibility with social anxiety in schizophrenia spectrum disorders.

Though often overlooked clinically, social anxiety appears to be unusually common in schizophrenia and may represent a barrier to quality of life and wellness. To explore the possible roots of social anxiety in schizophrenia, we concurrently assessed delusions using the Positive and Negative Syndrome Scale, flexibility of abstract thought using the Wisconsin Card Sorting Test, capacity for interpersonal relations using the Quality of Life Scale and social anxiety using the Liebowitz Social Anxiety Scale among 71 participants with schizophrenia or schizoaffective disorder. ANOVA revealed participants classified as having both significant delusions and impairments in flexibility of abstract thought (n=11) had significantly higher levels of social anxiety and fewer psychological resources for interpersonal relationships than participants with only one or neither of these difficulties. Groups did not differ on demographic variables, awareness of illness or negative symptoms. Clinical and theoretical implications are discussed.

Adult↗
PubMed2006

Obsessive-compulsive and negative symptoms in schizophrenia: associations with coping preference and hope.

Although agreement exists regarding the high occurrence of obsessive-compulsive (OC) symptoms in schizophrenia, it is less clear how OC symptoms are related to the traditional symptoms of schizophrenia and co-occurring deficits. One possibility is that there may be two distinct groups of persons with schizophrenia who experience OC symptoms: one group with poor and another with relatively good function. In the present study, the relationships between OC symptoms, coping, and hope were examined among 67 persons with schizophrenia spectrum disorders. First, participants with significant levels of OC symptoms were compared with participants without OC symptoms. Then, participants with significant levels of both OC symptoms and negative symptoms were compared with participants with negative symptoms, but no OC symptoms, and to participants with neither OC symptoms nor negative symptoms. Analysis of variance revealed participants with significant levels of OC symptoms were significantly more likely to experience greater levels of hopelessness and endorse a preference for avoidant focused coping strategies relative to participants without significant OC symptoms. Participants with both negative symptoms and OC symptoms also had less hope and greater preferences for ignoring stressors than participants with negative symptoms but no OC symptoms and participants with neither OC symptoms nor negative symptoms. Implications for theory, practice and research are 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

Narrative enrichment in the psychotherapy for persons with schizophrenia: a single case study.

Recovery from schizophrenia may involve persons developing a renewed sense of their illness, identity, agency, and worth within their life stories. To explore the requirements and challenges of psychotherapy that could facilitate this, we present a case study of a person with schizophrenia enrolled in treatment for over 19 months. Observed challenges to this process include the therapist's inclinations to "fix" the client, the client's own deficits and symptoms, and discomfort within the therapeutic relationship. Techniques to address these difficulties are presented, along with an objective means of assessing the treatment outcomes in terms of changes in narrative processes.

Adult↗
PubMed2006

The Scale to Assess Narrative Development: association with other measures of self and readiness for recovery in schizophrenia spectrum disorders.

While changes in self-experience have been suggested as an element of recovery from schizophrenia, little is known about how they are linked with other subjective indicators of recovery. To examine this, we have developed methods of eliciting narratives of self and illness in schizophrenia and quantitatively rating self-experience expressed within those narratives. In this study, we rated the narratives of 34 persons with schizophrenia spectrum disorder prior to entry into rehabilitation using the Scale to Assess Narrative Development (STAND). STAND scores were then correlated with concurrent assessments of self-esteem using the Rosenberg Self Esteem schedule and readiness for change using the Stages of Change Questionnaire. Results indicated that higher ratings on the STAND were associated with greater levels of self-esteem and greater overall readiness for change. This may suggest that qualities of self-experience within personal narratives of persons with schizophrenia are linked to objective and subjective assessments of recovery.

Attitude to Health↗
PubMed2006

Cluster B and C personality traits, symptom correlates, and treatment utilization in postacute schizophrenia.

Unusually high levels of Cluster B and C personality traits have been observed in schizophrenia. While these have been linked to poorer function, less clear is the association of these personality traits with symptoms and service utilization. To examine this issue, 46 participants with schizophrenia or schizoaffective disorder were administered the Millon Clinical Multiaxial Inventory, Third Edition, and the Positive and Negative Syndrome Scale, and an inventory was taken of medical and psychiatric service utilization. Two sets of multiple regression analyses using Cluster B and C traits to predict treatment utilization and symptoms revealed that emotional discomfort symptoms were significantly related to level of borderline traits. Higher levels of positive symptoms were linked with more avoidant traits and fewer dependent traits. Higher levels of negative symptoms were linked with greater avoidant traits. Service utilization was predicted by borderline, antisocial, and avoidant traits. Implications for rehabilitation and treatment are discussed.

Ambulatory Care↗
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

Awareness of illness in schizophrenia: associations with multiple assessments of executive function.

Though insight in schizophrenia is correlated with flexibility in abstract thought, it is unclear how differing dimensions of executive functions are linked to insight. Accordingly, the authors administered the Scale to Assess Unawareness of Mental Disorder and the Delis-Kaplan Executive Function System to 53 participants with schizophrenia spectrum disorders. Spearman Rho correlations revealed that symptom awareness was significantly related to Verbal Fluency, Color-Word, Tower, and Word Context scores. Awareness of treatment need was related to Color-Word, Tower, and Word Context tasks. Results suggest insight may be related to capacities to shift attention between differing environmental demands, plan ahead, and construct contextual understandings.

Adult↗
PubMed2006

Facilitating the emergence of interpersonal relatedness in individual psychotherapy of schizophrenia: a case study.

Persons with schizophrenia possess enduring deficits that limit their capacity for interpersonal relatedness. Yet meaningful bonds form and are sustained during the process of psychotherapy. To better understand this phenomenon we analyzed the threats to relatedness and therapist actions in one case of long-term integrative psychotherapy. In these analyses we found relatedness was facilitated by the therapist's attitude of sympathy followed by their assistance filtering, recalling and considering in a flexibly abstract manner relevant material.

Adult↗
PubMed2006

Enactment in schizophrenia: capacity for dialogue and the experience of the inability to commit to action.

While research has steadily begun to explore thoughts and beliefs linked with helplessness and despair in schizophrenia, it is less clearly understood how to account phenomenologically for the related experience of being unable to commit to action in the midst of grave discomfort. To explore this issue, the current paper presents an analysis of the experience of volitional paralysis of two persons over the course of long-term integrative psychotherapy. In particular, we explore the experience of the inability to commit to action and the consequences of the gradual recovery of a sense that one is capable of action. Results suggest that in both cases inaction was tethered to a sense of self as insufficiently centered to survive action. In particular, we suggest both men appeared initially unable to commit to action because such a commitment threatened them with forces both felt would undo the tenuous conversations that comprised their identities. Finally, as a sense of self as capable of action emerged, both men began to experience themselves as relatively more complex human beings and to sustain more complex conversation within themselves and between themselves and others. Implications for psychotherapy and rehabilitation are discussed.

Adaptation, Psychological↗
PubMed2005

Association of neurocognition, anxiety, positive and negative symptoms with coping preference in schizophrenia spectrum disorders.

It is recognized that persons with schizophrenia tend to cope with stress in a relatively avoidant and ineffectual manner and that this coping style is linked to poorer outcome. Less is understood, however, about the interrelationship between symptoms, deficits in neurocognition and coping style in schizophrenia. To determine the extent to which various neurocognitive deficits and symptoms are related to coping style in schizophrenia, measures of positive symptoms, negative symptoms, state and trait anxiety levels, verbal memory and executive function were correlated with self-report of preference for a range of active and avoidant coping strategies. Participants were 42 persons with schizophrenia spectrum disorders enrolled in outpatient psychiatric care. Stepwise multiple regressions indicated that greater preferences for taking action when faced with a stressor were significantly (p<.05) linked to lesser positive symptoms and lesser state anxiety while greater preferences for thinking or talking about possible solutions were linked to lesser impairments in neurocognition. A greater preference for resigning in the face of stress was significantly linked to greater levels of negative symptoms and trait anxiety, while a preference to ignore stressors was linked to both greater levels of positive symptoms and graver impairments in neurocognition. Implications for understanding the genesis of psychosocial dysfunction and for the development of rehabilitative interventions are discussed.

Adaptation, Psychological↗
PubMed2005

Relationship of impaired processing speed and flexibility of abstract thought to improvements in work performance over time in schizophrenia.

Vocational impairments in schizophrenia have been widely linked to deficits in neurocognition. This study examined the possibility that deficits in visuomotor processing speed and flexibility in abstract thought may in combination be an especially potent risk factor for poorer levels of work performance in rehabilitation. Fifty-seven participants with confirmed diagnoses of schizophrenia spectrum disorders were administered the Digit Symbol Subtest and the Wisconsin Card Sorting Test and then offered work placements in a vocational rehabilitation program. Work performance was assessed biweekly over two months using the Work Behavior Inventory. Multivariate and univariate repeated ANOVA revealed that participants classified as having no impairments in either visuomotor processing speed and flexibility in abstract thought (n=14) had superior work performance compared to participants with deficits in either one area (n=20) or both areas (n=23). Additionally, participants with no impairments were the only group to show significant improvement in work performance over 7 weeks of rehabilitation. Participants with only one deficit had significantly better work performance than participants with both deficits but showed no statistically significant improvement in work performance. Results suggest assessments of these domains of neurocognition may provide important information about individual needs for adjunct services.

Adult↗