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CGT voor patiënten met postpsychotische demoralisatie ...Samenvatting
In dit artikel wordt geschetst hoe postpsychotische demoralisatie en zelfstigmatisatie bij patiënten met schizofrenie te behandelen. Dit wordt geplaatst in de context van een cognitief model van demoralisatie. Hierbij ligt de nadruk op overdreven negatieve verwachtingen omtrent de eigen capaciteiten en sociale acceptatie. Deze verwachtingen vinden hun basis in de verliezen en cognitieve achteruitgang die patiënten hebben ondergaan, maar zijn desalniettemin vaak onrealistisch en werken vermijding en inactiviteit in de hand. Twee patiënten worden beschreven. Beiden hebben ziektebesef en ziekte-inzicht, maar zitten vast in een toestand van demoralisatie met zelfstigmatiserende ideeën. Bij beide patiënten werd vooruitgang geboekt door creatief cognitief-gedragstherapeutische technieken toe te passen. Het doel was niet herstel tot hun oorspronkelijk niveau van functioneren, maar om ze te helpen bij het doorbreken van isolatie en inactiviteit.
Summary
In this article a treatment is presented for post-psychotic demoralisation and self-stigmatization in patients with schizophrenia. This is placed within the context of a cognitive model of demoralisation. Its focus is on patients’ negative expectations concerning their capabilities and social exclusion. These expectations are based on experiences of loss, shame and cognitive deterioration. Yet, they are often unrealistic and lead to avoidance and inactivity. The treatments of two patients are described. Both have insight into their illness, but are trapped in a state of demoralisation and self-stigmatizing thought patterns. In both patients, progress was achieved by creatively using cognitive behavioural techniques. The goal was not to restore the patients to their old level of functioning, but rather to help them overcome isolation and inactivity.
Referenties
Beck, A.T. (1952). Successful outpatient psychotherapy of a chronic schizophrenic with a delusion based on borrowed guilt. Psychiatry, 15, 305-312.
Cockram, C.A., Doros, G., & Figueiredo, J.M. de (2009). Diagnosis and measurement of subjective incompetence: the clinical hallmark of demoralization. Psychotherapy and Psychosomatics, 78, 342-345.
Gard, D.E., Kring, A.M., Gard, M.G., Horan, W.P., & Green, M.F. (2007). Anhedonia in schizophrenia: distinctions between anticipatory and consummatory pleasure. Schizophrenia Research, 93, 253-260.
Garety, P.A. & Freeman, D. (1999). Cognitive approaches to delusions: A critical review of theories and evidence. British Journal of Clinical Psychology, 38(Pt 2), 113-154.
Gould, R.A., Mueser, K.T., Bolton, E., Mays, V., & Goff, D. (2001). Cognitive therapy for psychosis in schizophrenia: An effect size analysis. Schizophrenia Research, 48(2-3), 335-342.
Granholm, E., Ben-Zeev, D., & Link, P.C. (2009). Social desinterest attitudes and group cognitive-behavioral social skills training for functional disability in schizophrenia. Schizophrenia Bulletin, 35, 874-883.
Grant, P. & Beck, A.T. (2009). Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophrenia Bulletin, 35, 798-806.
Gumley, A. & Schwannauer, M. (2006). Staying well after psychosis; a cognitive interpersonal approach to recovery and relapse precention. West Sussex: John Wiley & Sons Ltd.
Hodgekins, J. & Fowler, D. (2010). CBT and recovery from psychosis in the ISREP trial: mediating effects of hope and positive beliefs on activity. Psychiatric Services, 61, 321-324.
Kapur, S. (2003). Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry, 160, 13-23.
Karow, A. & Pajonk, F.G. (2006). Insight and quality of life in schizophrenia: recent findings and treatment implications. Current Opinion in Psychiatry, 19(6), 637-641.
Kingdon, D.G. & Turkington, D. (2006). Cognitive therapy of schizophrenia. London and New York: The Guilford Press.
Kissane, D.W., Clarke, D.M., & Street, A.F. (2001). Demoralization syndrome – a relevant psychiatric diagnosis for palliative care. Journal of palliative care, 17, 12-21.
Leucht, S., Arbter, D., Engel, R.R., Kissling, W., & Davis, J.M. (2009). How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials. Molecular Psychiatry, 14(4), 429-447.
Lysaker, P.H., Bryson, G.J., & Bell, M.D. (2002). Insight and work performance in schizophrenia. Journal of Nervous and Mental Disease, 190, 142-146.
Lysaker, P.H., Roe, D., & Yanos, P.T. (2006). Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin, 33, 192-199.
Mizrahi, R., Kiang, M., Mamo, D.C., Arenovich, T., Bagby, R.M., Zipursky, R.B., et al. (2006). The selective effect of antipsychotics on the different dimensions of the experience of psychosis in schizophrenia spectrum disorders. Schizophrenia Research, 88(1-3), 111-118.
Mohamed, S., Rosenheck, R., McEvoy, J., Swartz, M., Stroup, S., & Lieberman, J.A. (2009). Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophrenia Bulletin, 35, 336-346.
National Institute for Health and Clinical Excellence (2009). Schizophrenia; core interventions in the treatment and management of schizophrenia in primary and secondary care (update). http://www.nice.org.uk/nicemedia/pdf/CG82FullGuideline.pdf
Pfammatter, M., Junghan, U.M., & Brenner, H.D. (2006). Efficacy of psychological therapy in schizophrenia: Conclusions from meta-analyses. Schizophrenia Bulletin, 32(Suppl. 1), S64-80.
Rector, N. (2004). Dysfunctional attitudes and symptom expression in schizophrenia: differential associations with paranoid delusions and negative symptoms. Journal of cognitive psychotherapy, 18, 163-172.
Staring, A.B.P., & Gaag, M. van der (2010). Cogntieve gedragstherapie voor demoralisatie bij schizofrenie. Gedragstherapie, 43, 205-224.
Staring, A.B.P., Gaag, M. van der, Berge, M. van den , Duivenvoorden, H.J., & Mulder, C.L. (2009). Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophrenia Research, 115, 363-369.
Szöke, A., Trandafir, A., Dupont, M.E., Méary, A., Schürhoff, F., & Leboyer, M. (2008). Longitudinal studies of cognition in schizophrenia: meta-analysis. British Journal of Psychiatry, 192, 248-257.
Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2008). Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34(3), 523-537.
Zimmermann, G., Favrod, J., Trieu, V.H., & Pomini, V. (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: A meta-analysis. Schizophrenia Research, 77(1), 1-9.