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Psychosocial approaches - 2 Enhancing recovery and staying well
Published in Kathy J Aitchison, Karena Meehan, Robin M Murray, First Episode Psychosis, 2021
Kathy J Aitchison, Karena Meehan, Robin M Murray
The outlook for the person who presents with a first psychotic episode depends not only on the quality of the treatment they receive but also on the nature of the illness which gave rise to the initial breakdown. As the majority of first psychotic episodes are manifestations of either schizophrenia or bipolar affective disorder, one might think that the long-term outcome would be greatly influenced by which of these illnesses appears to underly the psychosis. However, as already discussed in Chapter 2, it can be difficult to make a reliable diagnosis in the first few months after the manifestation of psychotic symptoms. Furthermore, Van Os etal,22 who followed-up a series of 166 recent-onset psychotic patients, found that description in terms of dimensions of psychosis was a better predictor of outcome than DSMIIIR diagnoses. Thus, those patients who showed an insidious onset and blunted affect tended to follow a chronic course while those patients who showed little insight had an outcome punctuated by compulsory admissions. The best outcome was found in those patients who had prominent affective symptoms, especially mania.
Descriptive and Psychodynamic Psychopathology EMIs
Published in Michael Reilly, Bangaru Raju, Extended Matching Items for the MRCPsych Part 1, 2018
Alexithymia.Anhedonia.Apathy.Blunted affect.Depression.Ecstasy.Elation.Euphoria.Flattened affect.Labile affect.
Attachment theory 1 and looked-after children
Published in Dr Quentin Spender, Dr Judith Barnsley, Alison Davies, Dr Jenny Murphy, Primary Child and Adolescent Mental Health, 2018
Dr Quentin Spender, Dr Judith Barnsley, Alison Davies, Dr Jenny Murphy
Attachment disorders are more extreme still in their behavioural and emotional manifestations. They are usually seen in children who have been institutionalised, severely neglected or have been looked after by multiple caregivers. Characteristic features include some or several of the following: not being able to establish a specific main attachment figureindiscriminate friendship towards strangerslack of explorationexcessive clinginessblunted affectsocial withdrawalexcessive vigilance (sometimes ‘frozen watchfulness’)hyper-compliancea mixture of simultaneous approach and avoidanceinverted parenting (the child looks after the parent).
Negative symptom configuration in first episode Schizophrenia: findings from the “Parma Early Psychosis” program
Published in Nordic Journal of Psychiatry, 2020
Lorenzo Pelizza, Giulia Landi, Clara Pellegrini, Emanuela Quattrone, Silvia Azzali, Pietro Pellegrini, Emanuela Leuci
A second factor (including PANSS “Blunted Affect”, “Emotional Withdrawal” and “Motor Retardation” items) only partially overlaps with the “Expressive Deficits” domain previously identified by Jang and colleagues [36]. Indeed, it is characterized by a mix of affective flattening (i.e. diminished emotional responsiveness as evidenced by a reduction in facial expression, modulation of feelings and communicative gestures), lack of interest in and affective involvement with life’s events, and decrease in motor activity (as reflected in reduced responsiveness to stimuli) [14]. Inconsistently with what reported in other factor analysis studies, this is the only PANSS negative dimension significantly associated with baseline functioning decline in our FES total sample, posing as a specific early feature of poor psychosocial adjustment already at the onset of schizophrenia. In accordance with Marder and Galderisi [43], the main hypothesis on the pathogenesis of blunted affect in schizophrenic disorder includes abnormalities in emotion identification/discrimination and, more in general, in perception of nonverbal social cues. As an alternative, a deficit of motor expression was also proposed [46]: indeed, patients with motor disturbances are prone to impairments in nonverbal communication. Underlying pathophysiological mechanisms of affective flattening may vary (e.g. abnormalities of the basal ganglia, frontal lobe dysfunction); an abnormal functioning of mirror neuron system has also been recently hypothesized [47].
First-episode psychosis induced by pregabalin withdrawal: a case report
Published in Psychiatry and Clinical Psychopharmacology, 2018
İbrahim Gundogmus, Abdulkadir Karagöz, Ayhan Algül
A psychiatric examination that was compatible with the patient’s age was conducted. The examination found that the patient had poor self-care, slowed psychomotor activity, and disorganized behaviour. Further, the patient was diagnosed with having a dysphoric mood disorder and a blunted affect. He was also experiencing visual and auditory hallucinations; however, there were no signs that the patient was experiencing depersonalization-derealization disorder. Additionally, the examination found that the patient was experiencing impoverished thought content, decreased speed of thought, and loose associations. An EEG, a brain MR, laboratory tests, and a neurology consultation were conducted. The results were within normal limits.
Clinical validation of the Symptom Self-rating Scale for Schizophrenia (4S) among inpatients
Published in Nordic Journal of Psychiatry, 2021
Pernille Kølbæk, Daniel Guinart, Mark Opler, Christoph U. Correll, Ole Mors, Søren D. Østergaard
Table 2 lists the logistic regression coefficients for the individual 4S questions of the subscales for Delusions, Negative symptoms and Thought disorder items as well as the corresponding PANSS-6 items. The Spearman's rank correlation coefficients for the 4S Negative symptoms score and the individual three negative items in the PANSS-6 were N1 Blunted affect: rho = 0.36, p < 0.001, N4 Passive/apathetic social withdrawal: rho = 0.19, p = 0.08, and N6 Lack of spontaneity and flow of conversation: rho = 0.24, p = 0.02.