RESUMEN
Controversy exists regarding whether unawareness/denial of illness in schizophrenia results from neurocognitive deficits or a rejection of stigmatized social roles. One possibility is that some elements of a narrative of mental illness are primarily a matter of personal/social construction while others may be uniquely curtailed by neurocognitive deficits. Accordingly, we gathered narratives of illness among 52 persons with schizophrenia spectrum disorders using a semi-structured interview. Ratings of the plausibility, adequacy of detail, and temporal conceptual organization of each narrative were correlated with assessments of neurocognition, symptoms, and traditional insight measures. Degree of plausibility was significantly related to performance on the Wisconsin Card Sorting Test (WCST), a measure of executive function and levels of Positive symptoms on the Positive and Negative Syndrome Scale (PANSS). When entered into a regression to predict plausibility, positive symptoms and WCST performance made unique contributions (R2 = .51, p < .0001). Higher levels of Positive symptoms were associated with poorer temporal conceptual organization within narratives. Adequacy of detail within narratives of illness was related to traditional insight measures but not neurocognition or symptoms.
Asunto(s)
Actitud Frente a la Salud , Trastornos del Conocimiento/etiología , Narración , Esquizofrenia/complicaciones , Concienciación , Femenino , Humanos , MasculinoRESUMEN
Many researchers have hoped vocational rehabilitation might help people with schizophrenia not only to work but also to develop more coherent narratives of their abilities and the boundaries imposed by their condition. This study compared narrative accounts of persons with schizophrenia spectrum disorders (n = 16) generated using the Indiana Psychiatric Illness Interview prior to and 5 months following entry into a vocational rehabilitation program. Results revealed participants with more intact levels of neurocognitive function as assessed with the Wisconsin Card Sorting Test demonstrated significant gains in narrative coherence relative to those with greater levels of deficit (F(1,14) = 6.3, p = .02).
Asunto(s)
Narración , Rehabilitación Vocacional , Esquizofrenia/rehabilitación , Lenguaje del Esquizofrénico , Psicología del Esquizofrénico , Adulto , Aptitud , Terapia Combinada , Formación de Concepto , Estudios de Seguimiento , Humanos , Entrevista Psicológica , Masculino , Persona de Mediana Edad , Pruebas NeuropsicológicasRESUMEN
While hopelessness has been widely observed in schizophrenia and its clinical significance accepted, research has been equivocal regarding its relationship to symptoms and neurocognition. One possible reason for this is that different domains of hope have differential relationships to outcome. To explore this possibility, two aspects of hope, expectations of the future and motivation to persist were assessed along with neurocognition, personality, symptoms and social function among 52 persons in a post acute phase of schizophrenia. Multiple regressions revealed that neuroticism, verbal memory and income were each uniquely related to expectations of the future, accounting for almost one half of the variance (F=14.3, p<0.0001). By contrast, neuroticism and social isolation were uniquely related to motivational hope (F=13.6, p<0.0001), accounting for 35% of the variance. Positive and negative symptoms were unrelated to either form of hopelessness. Implications for research, and the development of interventions are discussed.
Asunto(s)
Trastornos del Conocimiento/epidemiología , Trastorno Depresivo Mayor/epidemiología , Trastornos de la Personalidad/epidemiología , Esquizofrenia/epidemiología , Conducta Social , Adulto , Trastornos del Conocimiento/diagnóstico , Estudios Transversales , Trastorno Depresivo Mayor/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Masculino , Trastornos de la Personalidad/diagnóstico , Calidad de Vida , Recuperación de la Función , Esquizofrenia/terapia , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
Although many persons with schizophrenia report significant levels of hopelessness, less is understood about the impact of hopelessness on functioning. This study examined the relationship between initial ratings of hopelessness and work functioning in the third week of a vocational rehabilitation program for 34 veterans with a diagnosis of a schizophrenia-spectrum disorder. Pearson correlations revealed that poorer task performance was associated with perhaps unrealistic expectations of success, whereas poorer interpersonal functioning at work was associated with poorer motivation. The findings suggest that specific domains of hopelessness are associated with different aspects of work functioning.