Life In Psychosis Research Articles

La clinique de la dépersonnalisation. Les destins du sens interne et la subjectivation de la vie dans la psychose. Le cas d’Aurélie

ObjectivesThe article presents a clinical study of depersonalization syndrome. MethodWe present a typical case of this state in order to investigate the destinys of the internal sense in psychopathology, as well as the modes of subjectivation of life in psychosis. ResultsThe detailed study of Aurélie's case allows us to understand that depersonalization syndrome confronts the patient with an experience of desubjectivation where the very existence of the psychological subject is put into question. DiscussionThis leads us to question the clinical aspect of this phenomenon. Indeed, descriptions that do not go beyond a simple observation of the disorder of certain psychic functions (such as sensitivity or perception) seem to miss the point: the fact that this syndrome describes a major defect in the subject's relationship with life. ConclusionIt seems necessary to develop a clinical questioning, which, beyond traditional semiology, would pose the question of psychopathological variations no longer as deviations from the norm, but as modes of the subjectivation of life.

Overall cortisol, diurnal slope, and stress reactivity in psychosis: An experience sampling approach

ObjectiveResults from experimental studies suggest that psychosis and psychosis liability are associated with increased cortisol levels and blunted cortisol reactivity, and that use of antipsychotics may reduce these aberrations. Here, we report on overall cortisol, diurnal slope, and cortisol stress reactivity in everyday life in psychosis and psychosis liability using the experience sampling method (ESM). MethodsOur sample consisted of individuals diagnosed with psychotic disorder currently on (MPD; n = 53) or off antipsychotic medication (NMPD; n = 20), first-degree relatives of psychotic patients (REL; n = 47), and healthy volunteers (HV; n = 67). Saliva samples were collected throughout the day on six consecutive days and analyzed for cortisol levels. Simultaneously, stressfulness of the current activity was assessed with ESM questionnaires. ResultsWe found no group differences in overall cortisol level between groups, but REL had a steeper diurnal slope than HV; in MPD a trend was found in the same direction. Regarding reactivity to stressful activities, results indicated attenuation of the cortisol response in both patient groups compared to HV. ConclusionThese results do not confirm reports of increased cortisol levels in psychosis, but provide evidence of stress-related cortisol alterations in everyday life.

Subjective quality of life in psychosis: Evidence for an association with real world functioning?

Subjective quality of life (SQOL) is an established patient-reported outcome in psychosis. However, current self-report measures of SQOL may be affected by recall bias and may not fully capture dynamic changes in SQOL over time. This study aimed to examine the ecological validity of self-reported and momentary assessment measures of SQOL, and their association with emotional experience, social interaction and activity in real life, in both patients with psychotic disorder (n = 56) and controls (n = 71). Self-reported QOL was assessed with the WHO-QOL, momentary QOL and real life experiences were assessed with the Experience Sampling Method (ESM). Results show that both measures were significantly associated in patients and controls, and associations with emotional experience were most relevant, momentary QOL being a stronger predictor than self-reported QOL. The association between momentary QOL and negative affect was stronger in patients than in controls. Overall, momentary QOL was more consistently associated with affect, social interaction and activity, while self-reported QOL displayed a more narrow association with mostly affect. Concluding, concurrent assessment of self-reported QOL and momentary QOL showed that momentary QOL may enhance the ecological validity of SQOL measurement. Experience sampling research may broaden our perspective on SQOL and its associations with real life functioning.

Quality of Life in Psychosis: Prevalence and Associated Factors in a Nigerian Clinical Population

Aim of the study was to assess sociodemographic and clinical determinants of quality of life in psychotic patients in a general hospital population in Nigeria. Information was obtained on demography, duration of untreated illness (DUI) and functioning among Schizophrenia (368), schizoaffective disorder (70), and 214 patients with affective psychosis. Functioning was assessed using GAF, severity of psychopathology with PANSS and quality of life using WHOQoL-BREF. In general, the differences in the QoL across the three psychotic disorders were small. Linear regression analysis, showed that high GAF p<0.001, medication adherence, p=0.007 were associated with good QoL in schizophrenia, low PANSS p<0.001 and short DUI p=0.001 in schizoaffective disorder and low PANSS, high GAF p<0.001 respectively in affective psychosis. QoL and its determinants in psychosis are not absolutely different. More research is required in this area.

Cost-effectiveness and quality of life in psychosis: the pharmacoeconomics of risperidone

Schizophrenia is arguably the worst disease affecting humankind, costly in both social and financial terms. In the current cost-cutting climate, the focus is on economizing the delivery of health care, including reducing access to prescription drugs. Yet decreasing expenditures on drugs for severe illnesses, such as schizophrenia, is a false economy. Drugs account for only a small proportion of the total costs of treating schizophrenia, with inpatient hospital care comprising the greatest portion of total treatment costs. Thus the use of risperidone, a more effective but more expensive antipsychotic medication, can decrease the total cost of care for patients with chronic schizophrenia by decreasing the need for hospitalization. Fewer days spent in the hospital also often means a better quality of life for patients. This finding is illustrated by case histories of 3 patients, 2 with schizophrenia and 1 elderly patient with behavioral disturbances of dementia