Schizophrenia Experience Research Articles

Thought, language, and communication deficits and association with everyday functional outcomes among community-dwelling middle-aged and older adults with schizophrenia

Older adults with schizophrenia experience poorer community integration and social functioning compared to same-age peers with no mental health disorders; these individuals are at elevated risk for functional decline and early institutionalization in long-term care facilities. Deficits in thought, language, and communication (TLC; that is, thought disorder and alogia) are core features of schizophrenia and may worsen with age; however, little research focuses on the functional sequelae of these impairments among older adults with schizophrenia. The present study aimed to examine the relationships among age, TLC deficits, and functional outcomes in a sample of community-dwelling middle-aged and older adults with schizophrenia (N = 245; ages 40–85). Participants completed assessments of symptoms, neurocognition, TLC deficits, and functional outcomes. Two different categories of TLC deficits were examined: verbal underproductivity (i.e., alogia) and disconnected speech. Regression analyses, controlling for gender, age, Veteran status, smoking status, cognitive impairment, and symptom severity, found that disconnected speech predicted occupational functioning, while verbal underproductivity predicted capacity to communicate skillfully in semi-structured social situations, as well as community functioning across interpersonal, occupational, and everyday living domains. Exploratory mediation analyses found significant indirect effects of age, through TLC deficits, on certain functional outcomes. Targeted training to improve TLC deficits, especially verbal underproductivity, among older adults with schizophrenia could have downstream effects on community functioning, improving outcomes for a vulnerable group.

Caregiver burden in schizophrenia following paliperidone palmitate long acting injectables treatment: pooled analysis of two double-blind randomized phase three studies

The pooled analysis of two double-blind, randomized, multicenter, phase-3 studies evaluated predictors of improvement or worsening of schizophrenia-related caregiver burden following paliperidone palmitate long-acting injectables (1-monthly [PP1M] and 3-monthly [PP3M]) treatment. Caregivers were offered to complete the involvement evaluation questionnaire (involvement evaluation questionnaire; 31-item scale). Total, 1498 caregivers (intent-to-treat open-label analysis set, n = 1497; mean [SD] age: 51.5 [13.02] years, 27 countries) were included: 49% were parents and >50% caregivers spent >32 hours/week in caregiving. Majority of caregivers with considerable burden (n = 1405; mean [SD] baseline involvement evaluation questionnaire scores: 28.4 [15.07]) improved significantly from baseline to end-of-study (n = 756; mean [SD] change from open-label baseline to double-blind endpoint in long-acting injectable scores:−8.9 [14.73]); most improvements were seen in urging followed by worrying, tension, and supervision domains (mean [SD] change from open-label baseline to double-blind endpoint in involvement evaluation questionnaire scores, urging: −3.7 [6.45]; worrying:−2.6 [5.11]; tension:−2.3 [4.84]; supervision: −1.3 [3.69]). Improvements significantly correlated with relapse status, patient age, and age of diagnosis (p < 0.001) while long-acting injectable use at baseline, number, and duration of prior psychiatric hospitalizations (<24 months) had no significant correlation. Caregiver burden was significantly improved for patients on prior oral antipsychotics post-switching to long-acting injectable, with less impact on leisure days and hours spent in caregiving (p < 0.001). Family members of patients with schizophrenia experience considerable caregiver burden. Switching from oral antipsychotic to long-acting injectable can provide meaningful and significant improvement in caregiver burden.

FMRI capture of auditory hallucinations: Validation of the two-steps method.

Our purpose was to validate a reliable method to capture brain activity concomitant with hallucinatory events, which constitute frequent and disabling experiences in schizophrenia. Capturing hallucinations using functional magnetic resonance imaging (fMRI) remains very challenging. We previously developed a method based on a two-steps strategy including (1) multivariate data-driven analysis of per-hallucinatory fMRI recording and (2) selection of the components of interest based on a post-fMRI interview. However, two tests still need to be conducted to rule out critical pitfalls of conventional fMRI capture methods before this two-steps strategy can be adopted in hallucination research: replication of these findings on an independent sample and assessment of the reliability of the hallucination-related patterns at the subject level. To do so, we recruited a sample of 45 schizophrenia patients suffering from frequent hallucinations, 20 schizophrenia patients without hallucinations and 20 matched healthy volunteers; all participants underwent four different experiments. The main findings are (1) high accuracy in reporting unexpected sensory stimuli in an MRI setting; (2) good detection concordance between hypothesis-driven and data-driven analysis methods (as used in the two-steps strategy) when controlled unexpected sensory stimuli are presented; (3) good agreement of the two-steps method with the online button-press approach to capture hallucinatory events; (4) high spatial consistency of hallucinatory-related networks detected using the two-steps method on two independent samples. By validating the two-steps method, we advance toward the possible transfer of such technology to new image-based therapies for hallucinations. Hum Brain Mapp 38:4966-4979, 2017. © 2017 Wiley Periodicals, Inc.

Predictors of Disruptions in Breast Cancer Care for Individuals with Schizophrenia.

Patients with schizophrenia experience markedly increased breast cancer mortality, yet reasons for this disparity are poorly understood. We sought to characterize disruptions in breast cancer care for patients with schizophrenia and identify modifiable predictors of those disruptions. We performed a medical record review of 95 patients with schizophrenia and breast cancer treated at an academic cancer center between 1993 and 2015. We defined cancer care disruptions as processes that interfere with guideline-concordant cancer care, including delays to diagnosis or treatment, deviations from stage-appropriate treatment, and interruptions in treatment. We hypothesized that lack of psychiatric treatment at cancer diagnosis would be associated with care disruptions. Half of patients with schizophrenia experienced at least one breast cancer care disruption. Deviations in stage-appropriate treatment were associated with breast cancer recurrence at 5 years (p = .045). Patients without a documented psychiatrist experienced more delays (p = .016), without documented antipsychotic medication experienced more deviations (p = .007), and with psychiatric hospitalizations after cancer diagnosis experienced more interruptions (p < .0001). Independent of stage, age, and documented primary care physician, lack of documented antipsychotic medication (odds ratio [OR] = 4.97, 95% confidence interval [CI] = 1.90, 12.98) and psychiatric care (OR = 4.56, 95% CI = 1.37, 15.15) predicted cancer care disruptions. Disruptions in breast cancer care are common for patients with schizophrenia and are associated with adverse outcomes, including cancer recurrence. Access to psychiatric treatment at cancer diagnosis may protect against critical disruptions in cancer care for this underserved population. Disruptions in breast cancer care are common for patients with schizophrenia, yet access to mental health treatment is rarely integrated into cancer care. When oncologists documented a treating psychiatrist and antipsychotic medication, patients had fewer disruptions in breast cancer care after adjusting for age, cancer stage, and access to primary care. Addressing psychiatric comorbidity at breast cancer diagnosis may increase the likelihood that patients with schizophrenia receive timely, stage-appropriate cancer treatment. Comanagement of schizophrenia and breast cancer at cancer diagnosis may be one key strategy to decrease inequities in cancer treatment and improve cancer survival in this underserved population.

Memory impairment and the mediating role of task difficulty in patients with schizophrenia.

Using meta-analytic methods, we sought to synthesize the research literature on memory impairment in schizophrenia. Additionally, we compared performances across memory measures to determine if task difficulty (e.g., effortful encoding and retrieval vs non-effortful encoding and retrieval) could account for variance across studies. Our primary measures of interest included the California Verbal Learning Test, Wechsler Memory Scale, Rey Auditory Verbal Learning Test, Hopkins Verbal Learning Test, Rey-Osterrieth Complex Figure Test, and the Benton Visual Retention Test. We searched for all studies that met inclusion criteria using PubMed, PsycINFO, Scholars Portal Search, and Google Scholar. Studies were included if: (i) they were published after 1980; (ii) healthy controls were compared to patients with schizophrenia; (iii) at least one of the noted measures of interest was employed in the primary study; and (iv) the primary study included data that could be transformed to point estimate effect sizes (i.e., Cohen's d). Cohen's d was calculated between patients and healthy controls, along with overall 95% confidence intervals. A two-tailed independent samples t-test was conducted to assess if performance differed on various paired subtests of the same domain. Large effect sizes were found for all memory tests. No significant differences were found between subtests. In conclusion, patients with schizophrenia experience significant verbal and visual memory impairments, which are not explained by task difficulty. Patients were unable to learn or retrieve more reliably despite repetition and cuing strategies, suggesting that memory impairment in the illness is not a function of task difficulty.

Improving quality of life and physical health in patients with schizophrenia: A 30-month program carried out in a real-life setting.

Patients with schizophrenia experience low quality of life (QoL) and poor physical health, which is explained, in part, by unhealthy lifestyle, tobacco smoking, poor diet and sedentary behavior. To measure QoL and physical health in patients with schizophrenia and to quantify associations between QoL and physical health. This was a naturalistic longitudinal 30-month follow-up study including individual guidance, group sessions and treatment as usual. We included 190 patients. QoL was low among newly diagnosed patients. Higher body mass index was significantly associated with lower QoL. Newly diagnosed male patients showed lower QoL compared with females. Newly diagnosed patients experienced worsened health during the study period. In contrast, long-term schizophrenic patients started with worse physical health but improved with regard to weight, waist circumferences, intake of fast food and soft drinks, and light physical activity level. Newly diagnosed patients improved their QoL ( p = .056), and the psychological domain improved by 8.0 points ( p = .003). The number of interventions was positively associated with QoL. Patients with schizophrenia presented with low QoL and elevated risk factors for poor physical health. The intervention added onto 'treatment as usual' improved some risk factors for poor physical health among long-term patients. The number of interventions had an elevating effect on QoL in patients.

Journal Digest

Journal Digest

M28. Effect of Transcranial Direct Current Stimulation on Neurocognition, Social Cognition, and EEG in Schizophrenia

Background: Individuals with schizophrenia experience very high levels of disability and poor community outcome, resulting in a major public health concern. Over the last decades, the treatment of schizophrenia has shifted fundamentally from a focus on symptom reduction to a focus on recovery and improving aspects of functioning. In this study, we examined the effect of transcranial direct current stimulation (tDCS) on neurocognitive and social cognitive functions, as well as on brainwave activity, in individuals with schizophrenia. This procedure is noninvasive and results in increase or decrease of spontaneous neuronal firing in the brain. Unlike other noninvasive brain stimulation techniques, such as transcranial electrical stimulation or transcranial magnetic stimulation, tDCS does not induce neuronal firing by suprathreshold neuronal membrane depolarization, but rather modulates spontaneous neuronal network activity. Methods: Thirty-seven individuals with schizophrenia were administered 1 of 3 randomly assigned tDCS conditions per visit over the course of 3 visits, with approximately 1 week between each visit: anodal tDCS over left DLPFC (cathodal over right supraorbital), cathodal tDCS over left DLPFC (anodal over right supraorbital), and sham stimulation. The current intensity was set at 2 mA and was maintained for two 20-minute sessions, with a 1-hour break between the sessions. Neurocognitive functions were assessed using the MATRICS Consensus Cognitive Battery (MCCB). Social cognition was assessed using the Managing Emotions component of Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), the Emotion Identification Test from Ekman Program, the Profile of Nonverbal Sensitivity (PONS), and The Awareness of Social Inference Test (TASIT). Finally, EEG measures included standardized auditory oddball ERP and face perception protocols. Assessments were conducted immediately following each session, in a counterbalanced order of administration. Results: Despite the reasonably well-powered design, no systematic effects were found across the neurocognitive and social cognitive domains, and no significant effects were detected on EEG measures. Except for mild local discomfort (eg, itching and burning sensations at the site of the electrode), no significant side effects were reported, and no early termination of the procedure were requested. Conclusion: Findings demonstrate the safety and ease of administration of this procedure in schizophrenia, but raise dose and laterality related issues. It appears that repeated tDCS administration may be necessary to attain a therapeutic effect on cognition in schizophrenia.

Examination of Anomalous World Experience: A Report on Reliability

Background: The EAWE (Examination of Anomalous World Experience) is a newly developed, semi-structured interview that aims to capture anomalies of subjectivity, common in schizophrenia spectrum disorders, that pertain to experiences of the lived world, including space, time, people, language, atmosphere, and certain existential attitudes. By contrast, previous empirical studies of subjective experience in schizophrenia have focused largely on disturbances in self-experience. Aim: To assess the reliability of the EAWE, including internal consistency and interrater reliability. Sampling and Methods: In the course of developing the EAWE, two distinct studies were conducted, one in the United States and the other in Slovenia. Thirteen patients diagnosed with schizophrenia spectrum or mood disorders were recruited for the US study. Fifteen such patients were recruited for the Slovenian study. Two live interviewers conducted the EAWE in the US. The Slovenian interviews were completed by one live interviewer with a second rater reviewing audiorecordings of the interview. Internal consistency and interrater reliability were calculated independently for each study, utilizing Cronbach's α, Spearman's ρ, and Cohen's κ. Results: Each study yielded high internal consistency (Cronbach's α >0.82) and high interrater reliability for total EAWE scores (ρ > 0.83; average κ values were at least 0.78 for each study, with EAWE domain-specific κ not lower than 0.73). Conclusion: The EAWE, containing world-oriented inquiries into anomalies in subjective experience, has adequate reliability for use in a clinical or research setting.

Views on Antipsychotic Medication in Jordan: From the People Diagnosed with Schizophrenia Perspectives

Background: Antipsychotic medications are commonly used to ameliorate symptoms associated with psychotic disorders such as schizophrenia. The aim of this study was to investigate of the People Diagnosed with Schizophrenia (PDwS) experiences towards antipsychotic medication. Methods: A qualitative semi-structured interview was conducted with PDwS (n=22) to elicit their perspectives about antipsychotic medication. Results: Interviewees perceived antipsychotic medication is a source of threat to their wellbeing and identified several reasons for non-compliance, including lack of insight, dissatisfaction with mental health services and the illness nature and treatment. The participants attributed lack of family support as a reason for noncompliance. Moreover, many of these factors in Jordan are similar to noncompliance reasons in high income countries Conclusion: PDwS reported wide range of experiences and attitudes towards antipsychotic medication and this study identified the major factors for noncompliance with medication in low-income country. Therefore, the current mental health policy should be revised to address these factors in order to enhance adherence rate.

The Phenomenological Experience of Schizophrenia and Affective Function

This article proposes that the traditional presumption of affective dysfunction or dysregulation in schizophrenia may not be entirely accurate. Rather, it is argued, the experience of cognitive and perceptual symptoms, coupled with the individual’s perception of the challenges associated with their condition may provide a richer and more useful understanding of the emotional experience and expression of persons dealing with schizophrenia. Some of the important implications of this view are discussed in regard to therapy and other interventions.

Burden of care amongst caregivers who are first degree relatives of patients with schizophrenia.

IntroductionCaring for a mentally ill family member is a challenging task. Caregivers who are first-degree relatives (FDR) are at a higher risk of experiencing the negative consequences of caregiving. This study was aimed at determining burden of care and its correlates in caregivers who are first-degree relatives of patients with schizophrenia.MethodsA dyad of 255 patients and caregivers was recruited. A socio-demographic questionnaire was administered to both. The GHQ-12 was used to screen for psychiatric morbidity in the FDRs. Caregiver's burden was assessed with the Zarit Burden Interview. Patients' illness severity and level of functioning were assessed using the Brief Psychiatric Rating Scale and the Global Assessment of Functioning scales respectively.ResultsThe mean ± SD age of caregivers and patients were 45.1 ±12.3 and 36.7 ±13.4 years respectively. About 49% of caregivers experienced high burden of care. Older caregiver's age (r = 0.179; p < 0.004) and greater illness severity (r = 0.332; p < 0.0001) in the patient had weak to moderate positive correlation with burden of care. Caregiver's burden also increased with poorer functioning of the patient (r = -0.467 p < 0.0001). Independent predictors of caregiver burden were low level of education of the caregiver (OR 2.45; 95% CI 1.27-4.73), psychiatric morbidity in the caregiver (OR 6.74; 95% CI 2.51-18.15) and poor patient functioning (OR 2.81; 95% CI 1.27-6.18).ConclusionCaregivers who are first-degree relatives of patients with schizophrenia experience varying degrees of burden of care during caregiving. Routine screening and early psychological intervention would help to ameliorate these negative consequences of caregiving.

The Efficacy of Mindfulness-Based Cognitive Therapy on Resilience among the Wives of Patients with Schizophrenia.

The wives of patients with schizophrenia experience high levels of stress due to their spouses' disease, which leads to certain problems and decreased adaptability and efficiency in them. This study investigated the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) on resilience in schizophrenia patients. In this quasi-experimental study, 40 wives of patients with schizophrenia (20 assigned to experimental group and 20 to control group) whose husbands were kept in rehabilitation centers for mental disorders were enrolled according to convenience sampling. In the experimental group, the therapeutic protocol of MBCT was conducted. Accordingly, the patients were encouraged to process the experiences in a non-judgmental manner as they have been formed, and to change their relationship with and embrace challenging thoughts and feelings. Meanwhile, the control group underwent no intervention. The research instrument was Connor-Davidson Resilience Scale. Data were analysed by ANCOVA in SPSS 16. At post-test, mean resilience score of the experimental group (77.95±4.71) was much higher than that of the control group (71.75±5.81). There was a significant difference in the mean resilience score at post-test between the experimental and control groups (p<0.05). Training MBCT strategies was effective on resilience in the wives of schizophrenia patients. Therefore, this approach can be incorporated into mental health-related interventions for the families of patients with psychiatric disorders such as schizophrenia.

Visual Population Receptive Fields in People with Schizophrenia Have Reduced Inhibitory Surrounds.

People with schizophrenia (SZ) experience abnormal visual perception on a range of visual tasks, which have been linked to abnormal synaptic transmission and an imbalance between cortical excitation and inhibition. However, differences in the underlying architecture of visual cortex neurons, which might explain these visual anomalies, have yet to be reported in vivo. Here, we probed the neural basis of these deficits using fMRI and population receptive field (pRF) mapping to infer properties of visually responsive neurons in people with SZ. We employed a difference-of-Gaussian model to capture the center-surround configuration of the pRF, providing critical information about the spatial scale of the pRFs inhibitory surround. Our analysis reveals that SZ is associated with reduced pRF size in early retinotopic visual cortex, as well as a reduction in size and depth of the inhibitory surround in V1, V2, and V4. We consider how reduced inhibition might explain the diverse range of visual deficits reported in SZ.SIGNIFICANCE STATEMENT People with schizophrenia (SZ) experience abnormal perception on a range of visual tasks, which has been linked to abnormal synaptic transmission and an imbalance between cortical excitation/inhibition. However, associated differences in the functional architecture of visual cortex neurons have yet to be reported in vivo. We used fMRI and population receptive field (pRF) mapping to demonstrate that the fine-grained functional architecture of visual cortex in people with SZ differs from unaffected controls. SZ is associated with reduced pRF size in early retinotopic visual cortex largely due to reduced inhibitory surrounds. An imbalance between cortical excitation and inhibition could drive such a change in the center-surround pRF configuration and ultimately explain the range of visual deficits experienced in SZ.

Body Image and Body Experience Disturbances in Schizophrenia: an Attempt to Introduce the Concept of Body Self as a Conceptual Framework

Disturbances in body experience are described as key schizophrenia symptoms and early disease predictors. In case studies, different disorders relating to body experience are presented, but only a few empirical studies have aimed to distinguish the characteristics of body experience in schizophrenia, and these have been selected arbitrarily and without reference to cohesive theoretical model. To integrate this fragmentary approach, we propose a body self (BS) model, composed of: functions; representations (e.g., body image); and sense of body identity. The aim of the study was to determine whether the BS differentiates schizophrenic patients from healthy controls, and to investigate the relations between aspects of BS and a history of illness and clinical characteristics. The Body Self Questionnaire and the Positive and Negative Syndrome Scale were administered to 63 schizophrenic patients and 63 healthy subjects. The difference was found in the functions of the body-self (perceiving, interpreting, and regulating body experience), in the sense of body identity, and in one of three aspects of body image explored (e.g., acceptance of biological sex). Disturbances in BS were related to positive symptoms and to the number of hospitalizations for other diseases. Together, the results demonstrate that schizophrenia is more body experience than body image disorder, since the negative emotional attitude towards the body and acceptance of fitness were not distinctive for schizophrenia. The link between the disturbances in BS and the number of nonpsychiatric hospitalizations suggests that misinterpretation of body experiences in schizophrenia can promote a search for medical attention.

Do people with schizophrenia experience more negative emotion and less positive emotion in their daily lives? A meta-analysis of experience sampling studies

Research on emotion experience in response to valenced stimuli has consistently shown that people with schizophrenia have the capacity to experience emotion. Specifically, people with schizophrenia report similar experiences to both positive and negative emotion-eliciting stimuli as individuals without the disorder. However, it is less clear if people with schizophrenia experience similar levels of positive emotion and negative emotion outside of standardized laboratory contexts, as in their daily lives. One reliable method for assessing emotion experience in schizophrenia has been the Experience Sampling Method (ESM), or Ecological Momentary Assessment (EMA). Using the PRISMA guidelines for meta-analysis, we reviewed the literature for all studies that included people with and without schizophrenia, and that included a positive or negative emotion assessment during participants' daily lives. The current study is a meta-analysis of 12 EMA studies of emotion experience, which included a total of 619 people with schizophrenia and 730 healthy controls. Results indicate that people with schizophrenia consistently report more negative and less positive emotion than healthy control participants. These findings differ from laboratory-based studies, which may be due to several factors, including environmental differences, effects of the disorder that appear more clearly in daily life, or additional concerns, such as depression, which has been shown to be related to negative emotion in schizophrenia. Importantly, these findings are in line with questionnaire-based measures of emotion experience, lending some support for their use in research and clinical settings.

Effect of Adjunctive Raloxifene Therapy on Severity of Refractory Schizophrenia in Women

A substantial proportion of women with schizophrenia experience debilitating treatment-refractory symptoms. The efficacy of estrogen in modulating brain function in schizophrenia has to be balanced against excess exposure of peripheral tissue. Raloxifene hydrochloride is a selective estrogen receptor modulator (mixed estrogen agonist/antagonist) with potential psychoprotective effects and fewer estrogenic adverse effects. To determine whether adjunctive raloxifene therapy reduces illness severity in women with refractory schizophrenia. This 12-week, double-blind, placebo-controlled, randomized clinical trial with fortnightly assessments was performed at an urban tertiary referral center and a regional center from January 1, 2006, to December 31, 2014. Participants included 56 women with schizophrenia or schizoaffective disorder and marked symptom severity despite substantial and stable antipsychotic doses. Data were analyzed using intention to treat as the basis. Adjunctive raloxifene hydrochloride, 120 mg/d, or placebo for 12 weeks. The primary outcome was the change in the Positive and Negative Syndrome Scale (PANSS) total score. Clinical response (defined as a ≥20% decrease in PANSS total score from baseline) and change in PANSS subscale scores, mood, cognition, reproductive hormone levels, and adverse events were also assessed. Of the 56 participants (mean [SD] age, 53 [7.7] years; age range, 40-70 years; mean [SD] duration of psychotic illness, 24 [11] years), 26 were randomized to raloxifene and 30 were randomized to placebo. Raloxifene produced a greater reduction in the PANSS total score relative to placebo (β = -6.37; 95% CI, -11.64 to -1.10; P = .02) and resulted in an increased probability of a clinical response (hazard ratio, 5.79; 95% CI, 1.46 to 22.97; P = .01). A significant reduction was found in the PANSS general symptom scores for the raloxifene compared with the placebo (β = -3.72; 95% CI, -6.83 to -0.61; P = .02) groups. For patients who completed the full 12-week trial, there was not a statistically significant treatment effect on PANSS positive symptom scores (β for change in raloxifene vs placebo, -1.92; 95% CI, -3.83 to 0.00; P = .05). Change in mood, cognition, and reproductive hormone levels and the rate of adverse events did not differ between groups. Raloxifene hydrochloride, 120 mg/d, reduces illness severity and increases the probability of a clinical response in women with refractory schizophrenia. This large trial of raloxifene in this patient population offers a promising, well-tolerated agent that has potential application in clinical practice. clinicaltrials.gov Identifier: NCT00361543.

A Qualitative Study of the Subjective Appraisal of Recovery Among People with Lived Experience of Schizophrenia in Poland

The objective of this study was to explore definitions of recovery among Polish service users with lived experience of schizophrenia and to hear their recommendations regarding elements that should be considered in the planning of a recovery oriented psychosocial intervention. Four semi-structured focus groups were conducted in the Institute of Psychiatry and Neurology in Warsaw, Poland. A total of 28 service users’ narratives were examined using the inductive thematic analysis approach. Five main recovery themes emerged from the combined users accounts, listed in order of frequency: psychological dimension of recovery, relationships with others, wellness strategies, clinical understanding of recovery and support systems. Service user recommendations referred to the above identified recovery themes as well as indications that the intervention should be flexible, individualized, and facilitative of personal growth. The findings indicate that for service users with lived experience of schizophrenia in Poland it is culturally feasible to embrace the person-oriented approach to practice and develop a recovery-oriented psychosocial intervention emphasizing psychological domains of recovery such as positive identity, personal strengths, or meaning and purpose in life alongside the other relevant recovery dimensions. Actions regarding the system level of change are also required.

Disability and recovery in schizophrenia: a systematic review of cognitive behavioral therapy interventions.

BackgroundSchizophrenia is a disabling disease that impacts all major life areas. There is a growing need for meeting the challenge of disability from a perspective that extends symptomatic reduction. Therefore, this study aimed to systematically review the extent to which traditional and “third wave” cognitive – behavioral (CBT) interventions address the whole scope of disabilities experienced by people with lived experience of schizophrenia using the WHO’s International Classification of Functioning, Disability and Health (ICF) as a frame of reference. It also explores if current CBT interventions focus on recovery and what is their impact on disability domains.MethodsMedline and PsycINFO databases were searched for studies published in English between January 2009 and December 2015. s and full papers were screened against pre-defined selection criteria by two reviewers. Methodological quality of included studies was assessed by two independent raters using the Effective Public Health Practice Project Quality assessment tool for quantitative studies (EPHPP) guidelines.ResultsA total of 50 studies were included, 35 studies evaluating traditional CBT interventions and 15 evaluating “third wave” approaches. Overall, traditional CBT interventions addressed more disability domains than “third wave” approaches and mostly focused on mental functions reflecting schizophrenia psychopathology. Seven studies met the inclusion criteria of recovery-oriented interventions. The majority of studies evaluating these interventions had however a high risk of bias, therefore evidence on their effectiveness is inconclusive.ConclusionsTraditional CBT interventions address more disability domains than “third wave” therapies, however both approaches focus mostly on mental functions that reflect schizophrenia psychopathology. There are also few interventions that focus on recovery. These results indicate that CBT interventions going beyond symptom reduction are still needed. Recovery-focused CBT interventions seem to be a promising treatment approach as they target disability from a broader perspective including activity and participation domains. Although their effectiveness is inconclusive, they reflect users’ views of recovery and trends towards improvement of mood, negative symptoms and functioning are shown.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0912-8) contains supplementary material, which is available to authorized users.

Philosophy of psychiatry and phenomenology of everyday life: The disruptions of ordinary experience in schizophrenia

The paper considers the philosophy of psychiatry from the perspective of everyday life, as a particular structure of experience. We outline some questions raised by disturbances typical of psychotic disorders with regard to a phenomenology of the everyday and common sense. As a link between philosophy and clinical psychopathology, this phenomenology implies a transcendental point of view, embedded in concrete and practical forms of ordinary experience, along with social norms. This opens the possibility of a mutual questioning between philosophy and psychiatry, drawing on its clinical, epistemological, and ethical dimensions.