ABSTRACT
PURPOSE: The majority of people with schizophrenia has impaired insight, which is related to a poorer outcome. In this study, we evaluate a new psychosocial intervention 'REFLEX' aimed at improving insight in people with schizophrenia. REFLEX focuses on targeting stigma-sensitivity, perspective taking and self-reflection in people with schizophrenia and low insight. Primary objective is to improve insight and subsequently to improve functional outcome and symptoms. METHOD: A total of 121 people diagnosed with schizophrenia according to DSM IV criteria with impaired insight was included in 2012-2015 from seven sites in a multicenter randomized controlled trial. REFLEX was compared to an active control condition consisting of group-wise simplified cognitive remediation training. Primary outcome of the study were the preconditions of insight: internalized stigma, self-reflection, mental flexibility and perspective taking. Clinical insight and cognitive insight were secondary outcomes. RESULTS: Although perspective taking, self-reflection, mental flexibility and stigma sensitivity remained unchanged after the intervention, results showed a significant improvement of clinical insight in both conditions directly after treatment (SAI-E Rater, pâ¯<â¯.001, PANSS G12, pâ¯<â¯.005) and at follow-up (SAI-E Rater, pâ¯<â¯.01, SAI-E interview, pâ¯<â¯.001, PANSS G12, pâ¯<â¯.0001). Improvement of clinical insight directly after treatment was larger in the REFLEX condition (SAI-E Rater, pâ¯<â¯.05). Other outcomes (self-esteem, quality of life and depression) remained unchanged. CONCLUSION: Though insight improved in both conditions, REFLEX was not superior to simplified drill-and-practice cognitive remediation training. Nevertheless, this study indicates that structured interventions can significantly improve insight. Further research on the underlying mechanisms of both conditions is needed, as insight is unlikely to improve spontaneously in chronic patients.
Subject(s)
Psychotherapy, Group/methods , Psychotic Disorders/psychology , Psychotic Disorders/therapy , Schizophrenia/therapy , Schizophrenic Psychology , Adult , Cognition , Cognitive Remediation , Depression/psychology , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Quality of Life/psychology , Self Concept , Social Behavior , Social StigmaABSTRACT
Until recently, patients suffering from both a psychotic disorder and a post-traumatic stress disorder (PTSD) were hardly ever treated for their PTSD. Many clinicians considered that the reliving of the trauma during treatment could increase the risk of psychotic decompensation. We describe a trauma-focused cognitive behavioural therapy that was used to treat a 43-year-old patient diagnosed with both schizoaffective disorder and comorbid PTSD. After five sessions the patient no longer experienced PTSD symptoms.
Subject(s)
Schizophrenia/therapy , Schizophrenic Psychology , Stress Disorders, Post-Traumatic/therapy , Adult , Comorbidity , Female , Humans , Schizophrenia/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Treatment OutcomeABSTRACT
In December 2000, the Bone Marrow DonorBank Europdonor Nijmegen in The Netherlands celebrated its tenth anniversary. We describe the organisation and activities in the first 10 years of this regional bone marrow donor bank. A concise inquiry was sent to all transplant centres who had received a graft from our donors. Response rate was 88% and data were available from 127 recipients. Three donors donated twice to different patients. Median age of the 124 donors (42 females and 82 males) was 37 years and 30 years for the 127 recipients (48 females and 79 males). Time interval between first request of a blood sample and collection of bone marrow varied from 13 to 695 days (median, 113 days). All but two donors received general anaesthesia for 25-120 min (median; 60 min). Hospital stay has been reduced to 24 h. Most donors experienced pain from the collection sites for 3-5 days. However, 9 donors (7%) suffered from pain for 2-3 weeks. All but two donors (98%) were willing to donate a second time for the same patient and 119 (96%) donors wished to remain in the register. The number of nucleated cells (NC) in the collected marrow varied from 0.2 to 8.3 x 10(8)/kg body weight of the recipient (median, 3.5 x 10(8)/kg) with 6.4-470.0 x 10(4) CFU-GM/kg body weight of the recipient (median, 18.0 x 10(4)/kg body weight). The 3-year projected probability of survival of the 127 recipients transplanted with marrow from donors provided by Bone Marrow Donor Bank Europdonor Nijmegen was 27 +/- 9% (+/-95% CI).
