ANOMALOUS SELF-EXPERIENCE IN THE PRODROMAL PHASE OF SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
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services, carers generally considered clinicians approachable and responsive to their needs. They felt they were listened to and their situation taken seriously. (iv) Feeling undervalued as a carer. While, overall, clinicians were perceived as approachable and supportive, a competing theme is that some carers felt their contributions were undervalued and concerns were not listened to or taken seriously. This is reflected in two overlapping sub-themes: balancing confidentiality with the need-to-know, and not being taken seriously. Discussion: Accessing FEP services results in both negative and positive experiences and these competing situations are interrelated. Our findings highlight a number of key implications for primary caregivers, family workers, clinicians, and FEP services. First, greater awareness is needed of the contribution, experience and difficulties first-time primary caregivers face accessing services. Second, FEP services disadvantage carers who lack knowledge and assertiveness. Ideally, access should be determined more by clinical need than the level of carers' persistence. Indeed, there is a need to improve awareness, availability and access to FEP services, especially to those who are new to such programs. Third, ongoing family interventions are required for first-time caregivers, such as practical day-to-day support about accessing and getting the most out of services, as well as information regarding legal and financial supports and the possibility of respite. Fourth, clinical training should incorporate measures to increase sensitivity to carers' needs, and familiarity with government policies and mental health legislation about inclusion of carers. Finally, further national and international research is needed into the key findings and experience of carers accessing other health systems, and to understand the experience of non-engaged caregivers and those from culturally diverse Backgrounds who access FEP services. doi:10.1016/j.schres.2010.02.510 Poster 16 A DESCRIPTIVE PHENOMENOLOGICAL STUDY OF SYMPTOMS OF SCHIZOPHRENIA IN DEAF CLIENTS LaNiña E. Mompremier 1 , Irene W. Leigh 1 , Virginia Gutman 1 , Barbara Gerner De Garcia 1 , Mary Hufnell 1 , Caroline Kendall 2 1 Gallaudet University Washington, DC, USA; 2 Yale University West Haven, CT, USA Background: Our clinical knowledge and understanding of the manifestation of schizophrenia in deaf patients is limited. Previous studies address specific symptomatolgy observed in deaf persons with schizophrenia. The purpose of this research was to conduct extensive interviews of clinicians working with deaf patients diagnosed with schizophrenia in order to understand how clinicians characterized each patient's presentation and defined the sympto- matology observed. Methods: Supplemental interview data were gathered from client charts by clinicians. Eight clinicians with advanced sign language skills and extensive experience serving deaf clients with mental illness were recruited to discuss a total of 13 client cases. A qualitative investigation was employed to identify themes and patterns present in each clinicians' concepts of symptoms mani- fested in deaf patients diagnosed with schizophrenia. Results: Symptomatology observed by clinicians was consistent with diagnostic criteria established for hearing clients with schizophrenia. However, some symptom modality differences were noted in phenomena such as sign language and lip-reading hallucinations and the language-related symptoms reported. The majority of "auditory hallucinations" in this sample were ambiguous in that clients were unable to describe acoustic features and/or the message content of the "voices." Delusional content mirrored hearing samples. The most common language-related phenomena observed were characterized as loose associations as well as circumstantial and tangential communication. The theme of organization was encoun- tered multiple times throughout the interviews with clinicians. Schizophrenia was characterized by clinicians as a disease that disrupts major cognitive processes and erodes the brain's ability to organize information, which impairs the individual's mental and social functioning. Such disorganization caused misinterpretations of stimuli or perceptual disturbance and impacted motivation and drive as these relate to negative symptoms. Primary deficits reported were often related to the clients' decline in social functioning declines. Discussion: A major limitation of this study is that data are based solely on the judgments, accuracy, and thoroughness of the observations and interpretations of the mental health professionals serving these clients. The nuances of the presentation of schizo- phrenia in deaf patients and the richness of this qualitative data may benefit clinicians diagnosing schizophrenia in deaf patients and subsequently developing appropriate treatment and interven- tion programs designed for deaf individuals with schizophrenia. doi:10.1016/j.schres.2010.02.511 Poster 17 ANOMALOUS SELF-EXPERIENCE IN THE PRODROMAL PHASE OF SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS Barnaby Nelson, Alison Yung Orygen Youth Health Research Centre Melbourne, Victoria, Australia Background: Over the last fifteen years, there has been increased interest in the early phase of schizophrenia and other psychotic disorders. The focus was initially on the first episode of psychosis but soon reached further back to the pre-onset or prodromal phase. Several strategies have been introduced to identify individuals in the putatively prodromal phase of psychotic disorder. The most widely used of these approaches is the "ultra-high risk" (UHR) approach, which combines known trait and state risk factors for psychotic disorder. Phenomen- ological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of psychotic vulnerability, particularly of schizophrenia spectrum disorders. Disturbance of basic self-experience involves a disruption of the sense of agency and ownership of experience, associated with a variety of dissociative symptoms and anomalous cognitive and bodily experiences. In this study, we investigated the presence of basic self-disturbance in a UHR group and whether it predicted transition to psychotic disorder. Methods: 41 UHR subjects and 12 first episode psychosis subjects were recruited from Orygen Youth Health, Melbourne. 52 non- clinical control subjects were recruited from the community. Subjects were assessed for basic self-disturbance using the EASE questionnaire. A range of other clinical variables were also measured. Subjects were assessed at baseline and at 12 months follow up. Results: Preliminary data will be presented. Levels of self- disturbance were significantly higher in the UHR sample and the FEP sample compared to the non-clinical control group (p < .001). Further follow-up is required to assess the predictive utility of self- disturbance in the UHR sample. Discussion: Identifying self-disturbance in the UHR population may provide a means of further "closing in" on individuals truly at high risk of psychotic disorder, particularly of schizophrenia spectrum disorders, thus supplementing the UHR identification approach. This would be of practical value by reducing inclusion of "false positive" cases in ultra-high risk samples, and of theoretical value by shedding light on core features of psychotic pathology. doi:10.1016/j.schres.2010.02.512 Abstracts 306
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Transcript of ANOMALOUS SELF-EXPERIENCE IN THE PRODROMAL PHASE OF SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
services, carers generally considered clinicians approachable andresponsive to their needs. They felt they were listened to and theirsituation taken seriously. (iv) Feeling undervalued as a carer. While,overall, clinicians were perceived as approachable and supportive, acompeting theme is that some carers felt their contributions wereundervalued and concernswere not listened to or taken seriously. Thisis reflected in two overlapping sub-themes: balancing confidentialitywith the need-to-know, and not being taken seriously.Discussion: Accessing FEP services results in both negative andpositive experiences and these competing situations are interrelated.Our findings highlight a number of key implications for primarycaregivers, family workers, clinicians, and FEP services. First, greaterawareness is needed of the contribution, experience and difficultiesfirst-time primary caregivers face accessing services. Second, FEPservices disadvantage carers who lack knowledge and assertiveness.Ideally, access should be determined more by clinical need than thelevel of carers' persistence. Indeed, there is a need to improveawareness, availability and access to FEP services, especially to thosewhoare new to suchprograms. Third, ongoing family interventions arerequired for first-time caregivers, such as practical day-to-day supportabout accessing and getting the most out of services, as well asinformation regarding legal and financial supports and the possibilityof respite. Fourth, clinical training should incorporate measures toincrease sensitivity to carers' needs, and familiarity with governmentpolicies andmental health legislation about inclusion of carers. Finally,further national and international research is needed into the keyfindings and experience of carers accessing other health systems, andto understand the experience of non-engaged caregivers and thosefrom culturally diverse Backgrounds who access FEP services.
doi:10.1016/j.schres.2010.02.510
Poster 16A DESCRIPTIVE PHENOMENOLOGICAL STUDY OF SYMPTOMS OFSCHIZOPHRENIA IN DEAF CLIENTS
LaNiña E. Mompremier1, Irene W. Leigh1, Virginia Gutman1, BarbaraGerner De Garcia1, Mary Hufnell1, Caroline Kendall21Gallaudet University Washington, DC, USA; 2Yale University WestHaven, CT, USA
Background: Our clinical knowledge and understanding of themanifestation of schizophrenia in deaf patients is limited. Previousstudies address specific symptomatolgy observed in deaf personswith schizophrenia. The purpose of this research was to conductextensive interviews of clinicians working with deaf patientsdiagnosed with schizophrenia in order to understand how clinicianscharacterized each patient's presentation and defined the sympto-matology observed.Methods: Supplemental interview data were gathered from clientcharts by clinicians. Eight clinicians with advanced sign languageskills and extensive experience serving deaf clients with mentalillness were recruited to discuss a total of 13 client cases. Aqualitative investigation was employed to identify themes andpatterns present in each clinicians' concepts of symptoms mani-fested in deaf patients diagnosed with schizophrenia.Results: Symptomatology observed by clinicianswas consistentwithdiagnostic criteria established for hearing clients with schizophrenia.However, some symptom modality differences were noted inphenomena such as sign language and lip-reading hallucinationsand the language-related symptoms reported. The majority of"auditory hallucinations" in this sample were ambiguous in thatclients were unable to describe acoustic features and/or the messagecontent of the "voices." Delusional content mirrored hearingsamples. The most common language-related phenomena observed
were characterized as loose associations aswell as circumstantial andtangential communication. The theme of organization was encoun-tered multiple times throughout the interviews with clinicians.Schizophrenia was characterized by clinicians as a disease thatdisrupts major cognitive processes and erodes the brain's ability toorganize information, which impairs the individual's mental andsocial functioning. Such disorganization causedmisinterpretations ofstimuli or perceptual disturbance and impactedmotivation and driveas these relate to negative symptoms. Primary deficits reportedwereoften related to the clients' decline in social functioning declines.Discussion: A major limitation of this study is that data are basedsolely on the judgments, accuracy, and thoroughness of theobservations and interpretations of the mental health professionalsserving these clients. The nuances of the presentation of schizo-phrenia in deaf patients and the richness of this qualitative datamay benefit clinicians diagnosing schizophrenia in deaf patientsand subsequently developing appropriate treatment and interven-tion programs designed for deaf individuals with schizophrenia.
doi:10.1016/j.schres.2010.02.511
Poster 17ANOMALOUS SELF-EXPERIENCE IN THE PRODROMAL PHASE OFSCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
Barnaby Nelson, Alison YungOrygen Youth Health Research Centre Melbourne, Victoria, Australia
Background: Over the last fifteen years, there has been increasedinterest in the early phase of schizophrenia and other psychoticdisorders. The focus was initially on the first episode of psychosis butsoon reached further back to the pre-onset or prodromal phase. Severalstrategies have been introduced to identify individuals in the putativelyprodromal phase of psychotic disorder. The most widely used of theseapproaches is the "ultra-high risk" (UHR) approach, which combinesknown trait and state risk factors for psychotic disorder. Phenomen-ological research indicates that disturbance of the basic sense of selfmaybe a core phenotypic marker of psychotic vulnerability, particularly ofschizophrenia spectrum disorders. Disturbance of basic self-experienceinvolves a disruption of the sense of agency and ownership ofexperience, associated with a variety of dissociative symptoms andanomalous cognitive and bodily experiences. In this study, weinvestigated the presence of basic self-disturbance in a UHR group andwhether it predicted transition to psychotic disorder.Methods: 41 UHR subjects and 12 first episode psychosis subjectswere recruited from Orygen Youth Health, Melbourne. 52 non-clinical control subjects were recruited from the community.Subjects were assessed for basic self-disturbance using the EASEquestionnaire. A range of other clinical variables were alsomeasured.Subjects were assessed at baseline and at 12 months follow up.Results: Preliminary data will be presented. Levels of self-disturbance were significantly higher in the UHR sample and theFEP sample compared to the non-clinical control group (p<.001).Further follow-up is required to assess the predictive utility of self-disturbance in the UHR sample.Discussion: Identifying self-disturbance in the UHR population mayprovide a means of further "closing in" on individuals truly at highrisk of psychotic disorder, particularly of schizophrenia spectrumdisorders, thus supplementing the UHR identification approach.This would be of practical value by reducing inclusion of "falsepositive" cases in ultra-high risk samples, and of theoretical valueby shedding light on core features of psychotic pathology.
doi:10.1016/j.schres.2010.02.512
Abstracts306
