Editorial: the significance of psychotherapy in the age of neuroscience.
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Brain↗
Biomedical subjects
Wolfgang Tschacher
Publications and source records attributed to Wolfgang Tschacher.
Perception of causality in schizophrenia spectrum disorder.
Patients with schizophrenia spectrum disorders often maintain deviating views on cause-effect relationships, especially when positive and disorganization symptoms are manifest. Altered perceived causality is prominent in delusional ideation, in ideas of reference, and in the mentalizing ability (theory of mind [ToM]) of patients. Perceiving causal relationships may be understood either as higher order cognitive reasoning or as low-level information processing. In the present study, perception of causality was investigated as a low-level, preattentional capability similar to gestalt-like perceptual organization. Thirty-one patients (24 men and 7 women with mean age 27.7 years) and the same number of healthy control subjects matched to patients with respect to age and sex were tested. A visual paradigm was used in which 2 identical discs move, from opposite sides of a monitor, steadily toward and then past one another. Their coincidence generates an ambiguous, bistable percept (discs either "stream through" or "bounce off" one another). The bouncing perception, ie, perceived causality, is enhanced when auditory stimuli are presented at the time of coincidence. Psychopathology was measured using the Positive and Negative Syndrome Scale. It was found that positive symptoms were strongly associated with increased perceived causality and disorganization with attenuated perceived causality. Patients in general were not significantly different from controls, but symptom subgroups showed specifically altered perceived causality. Perceived causality as a basic preattentional process may contribute to higher order cognitive alterations and ToM deficiencies. It is suggested that cognitive remediation therapy should address both increased and reduced perception of causality.
Adult↗
Reduced perception of the motion-induced blindness illusion in schizophrenia.
Motion-induced blindness (MIB) occurs when target stimuli are presented together with a moving distractor pattern. Most observers experience the targets disappearing and reappearing repeatedly for periods of up to several seconds. MIB can be viewed as a striking marker for the organization of cognitive functioning. In the present study, MIB rates and durations were assessed in 34 schizophrenia-spectrum disorder patients and matched controls. The results showed that positive symptoms and excitement enhanced MIB, whereas depression and negative symptoms attenuated the illusion. MIB was more frequently found in normal subjects. The results remained consistent after adjusting for reaction time and error rates. Hence, MIB may provide a valid and reliable measure of cognitive organization in schizophrenia.
Adult↗
[A Qualitative Follow-Up Assessment two Years after Inpatient Crisis Intervention].
OBJECTIVE: 34 patients (50 % adjustment disorder) were investigated at admission, at discharge and 2 years after participating in a 2-week crisis intervention program. METHOD: Measures included SCL-90R, BDI and the Giessen-Test at all time points and a semi-structured interview at follow-up. RESULTS: Patients still suffered from residual symptoms at follow-up. Patients with a partner conflict were readmitted to inpatient care more often. Focussing the patient's perceived predominant problem during crisis intervention had a favourite follow-up outcome. CONCLUSIONS: Therapists should ensure repetitively that the predominant psychosocial problem according to the patient's view stays the focus of a crisis intervention. Individual assessment, especially regarding the preferred treatment modality during crisis intervention, may help to plan post intervention treatment.
Adjustment Disorders↗
Time series models of symptoms in schizophrenia.
The symptom courses of 84 schizophrenia patients (mean age: 24.4 years; mean previous admissions: 1.3; 64% males) of a community-based acute ward were examined to identify dynamic patterns of symptoms and to investigate the relation between these patterns and treatment outcome. The symptoms were monitored by systematic daily staff ratings using a scale composed of three factors: psychoticity, excitement, and withdrawal. Patients showed moderate to high symptomatic improvement documented by effect size measures. Each of the 84 symptom trajectories was analyzed by time series methods using vector autoregression (VAR) that models the day-to-day interrelations between symptom factors. Multiple and stepwise regression analyses were then performed on the basis of the VAR models. Two VAR parameters were found to be associated significantly with favorable outcome in this exploratory study: 'withdrawal preceding a reduction of psychoticity' as well as 'excitement preceding an increase of withdrawal'. The findings were interpreted as generating hypotheses about how patients cope with psychotic episodes.
Acute Disease↗
Time series modeling of heroin and morphine drug action.
RATIONALE: Clinical observations and recent findings suggested different acceptance of morphine and heroin by intravenous drug users in opiate maintenance programs. We postulated that this is caused by differences in the perceived effects of these drugs, especially how desired and adverse effects of both drugs interacted. OBJECTIVES: We measured the desired and adverse effects of high doses of injected morphine and heroin in patients to determine the causal interactions between both types of effects and test the hypothesis of a differential mechanism of action. METHODS: Thirty-three patients (five females, 28 males; mean duration of previous street heroin use 10.7 years, mean age 30.1 years) were randomly allocated double-blind to the substance groups. The average daily dose per participant in the heroin condition (n=17) was 491 mg, in the morphine condition (n=16) 597 mg. The observation period lasted 3 weeks; an average of 70 injections was received. After each injection of either substance, various aspects of drug effects were recorded systematically. Ratings were summarized into the factors "euphoria" and "adverse effects". Time series models were computed for each participant on the basis of the factor scores, using vector autoregression (VAR). RESULTS: A highly significant difference between the substances was found in the interaction between "euphoria" and "adverse effects". Adverse effects of heroin preceded higher euphoria, whereas adverse effects of morphine preceded subsequent lower euphoria. Additionally, the finding of a higher level of adverse effects in morphine was replicated. CONCLUSIONS: Results point to different mechanisms of action of the two opioids when the perceived drug effects are evaluated in a field setting. This may explain the better acceptance of heroin in opiate-assisted treatment of intravenous drug patients. The method used can be a valuable tool for the comparison of substance groups other than opioids.
Adult↗
Analysis of crisis intervention processes.
The remediation processes in psychosocial crisis intervention were modeled focusing on cognitive orientation. Frequent observations and subsequent process modeling constitute a novel approach to process research and reveal process-outcome associations. A sample of 40 inpatients who were assigned to treatment in a crisis intervention unit was monitored in order to study the process of crisis intervention. The process data consisted of patients' self-ratings of the variables mood, tension, and cognitive orientation, which were assessed three times a day throughout hospitalization (M = 22.6 days). Linear time series models (vector autoregression) of the process data were computed to describe the prototypical dynamic patterns of the sample. Additionally, the outcome of crisis intervention was evaluated by pre-post questionnaires. Linear trends were found pointing to an improvement of mood, a reduction of tension, and an increase of outward cognitive orientation. Time series modeling showed that, on average, outward cognitive orientation preceded improved mood. The time series models partially predicted the treatment effect, notably the outcome domain "reduction of social anxiety," yet did not predict the domain of symptom reduction. In conclusion, crisis intervention should focus on having patients increasingly engage in outward cognitive orientation in order to stabilize mood, reduce anxiety, and activate their resources.
Adult↗
[Evaluation of the bern day treatment programme and its position in the psychiatric network].
The Bern Day Treatment Programme offers cognitive-behavioural treatment to patients suffering from depression, eating disorders, anxiety disorders, and personality disorders. Treatment duration ranges from 12 to 20 weeks. Its concept is described in comparison to other similar institutions. To evaluate the programme the Beck Depression Inventory (BDI), the Symptom Check List (SCL-90-R), and the Change in Life Areas (VLB) were administered to 89 patients at admission and discharge. Their analyses revealed high symptom levels at admission and a significant improvement during treatment. Patients with personality disorders show less improvement in the VLB than patients without personality disorders. The results of the SCL-90-R indicate that the symptom levels at admission and the symptom reductions during treatment are similar to those of patients treated in inpatient units or in diagnostically specialised day treatment programmes. The Bern Day Treatment Programme seems to be feasible for highly impacted patients with non-psychotic disorders and might be a useful model for areas with low population density.
Ambulatory Care↗
Symptom trajectories in psychotic episodes.
Whereas the cross-sectional structure of schizophrenic symptoms has been studied extensively, little is known about the development of symptoms during acute episodes. In this study, symptom trajectories of 46 schizophrenia spectrum patients were examined based on daily observation during an average treatment period of 104 days. A novel time series approach was used to identify initial phases of response and other descriptive features of the trajectories. The results yielded five dynamical factors: (1) overall level of positive symptoms, (2) duration of nonspecific response, (3) slope of response in all symptom domains, (4) enduring negative symptoms, and (5) duration of response regarding psychoticity. Compared to patients with an acute schizophrenia-like psychotic disorder, schizophrenia and schizoaffective disorder patients ranked higher in factor 4 (enduring negative symptoms). They tended towards a lower level of positive symptoms and showed a less prominent response to treatment. The examination of a subsample of 19 patients with relapse indicated a prolonged duration of initial treatment response regarding psychoticity. The results support the validity of this approach for the description of symptom trajectories.
Acute Disease↗