Jonas Weijers, Peter Fonagy, Elisabeth Eurelings, Fabian - - PowerPoint PPT Presentation

Menta talizati tion and Psychosis

Jonas Weijers, Peter Fonagy, Elisabeth Eurelings, Fabian Termorshuizen, Wolfgang Viechtbauer, Jean-Paul Selten

Presenta tati tion about t research from baseline data ta

• f
• f MBT RCT

MBT RCT

• Randomized controlled trial on MBT for patients with

Non-affective Psychotic Disorders (schizophrenia, Schizoaffective disorder, delusional disorder etc.)

• Based in the Netherlands
• N=90
• Still 2 more years to go, so no data yet.

Menta talizing and sympto toms of psychosis

Frith (1992): positi tive and negati tive sympto toms expressions of impaired monitoring own menta tal sta tate te and impaired representation

• f oth

ther’s menta tal sta tate te, … i.e. impaired menta talizing ability. .

Impaired monito toring own menta tal sta tate tes:


• (Verbal) audito

tory hallucinati tions: faulty interpretation of one’s own thoughts as other people’s voices.

• Avoliti

tion (lack of moti tivati tion): the patient may have intentions, but is unaware of them and so is unable to translate them into behavior.

• De

Delusions of Contr trol: patient is unaware of intention preceding behavior and attributes it to external an source.

Impaired representa tati tion of oth ther’s menta tal sta tate tes

• De

Delusions of persecuti tion/reference by definition involve a faulty interpretation of others’ intentions.

• Flatte

ttening of affecti tive expression: Due to an inability to understand that gestures, intonation and facial expression convey mental states.

• Social dysfuncti

tion/with thdrawal: Inability to represent other’s mental states will severely complicate te social situ tuati tions, leading to with thdrawal.

De Developmenta tal natu ture of menta talizing

• Indeed people with psychotic disorder have severe menta

talizing deficits ts (Sprong, 2007)

• Frith

th under the impression that impaired mentalizing was the result of psychosis itself.

• Within Conte

text t of MBT menta talizing understood as an acquired ability th through inte teracti tion with sensitive and responsive parents.

Parenta tal Abuse and Menta talizing

• Inspired by Fonagy and Chiesa, we set out to examine

relation between abuse, mentalizing and symptoms in psychosis.

• Parental abuse represents severe lack of mentalizing ability

by the parent.

• May result in a phobic avoidance of menta

talizing on the part

• f the child (Chiesa and Fonagy, 2014).

Impaired Menta talizing as explanato tory mechanism betw tween CA and Psychosis outc tcome


Psychotic Symptoms

Impaired Mentalizing Childhood Abuse Child Childhood hood ab abuse use is a risk factor of ps psych ychos

• sis

is (Varese et al. 2012). Impaired menta talizing: negati tive sympto toms (Sergi, 2007) so soc c fun fun (Fett,2011). Less evidence for pos pos s sym ymp p (Garety, 1999) Child Childhood hood ab abuse use detrimental to menta talizing (Cichetti, 2003).

Meth thods

§ N = 90 outpatients with psychotic disorder (schizophrenia, schizoaffective disorder, psychotic disoder not otherwise specified, etc.) § Recruited from community treatment teams around Leiden, the Netherlands. § Drop-out: N = 3 § Tests:

– Childhood Experience of Care and Abuse. – Hinting Task (Mentalizing impairment). – Social Functioning Scale. – Positive and Negative Syndrome Scale.

Results ts: abuse

§ 36,8 % (32) of respondents reported no abuse. § 63,2 % (55) reported at least mild forms of abuse. § 37,9 % (33) reported at least one severe form of abuse.

Childhood Abuse Childhood Abuse Childhood Abuse Pos Symp Soc Fun Neg Symp (b = 0.11, P = 0.01) (b = 0.17, P < 0.01) MAIN FINDINGS

(b = 0.06, P = 0.03)

Childhood Abuse Mentalizing impairment MAIN FINDINGS

Mentalizing impairment Pos Symp Soc Fun Neg Symp

(P > 0.7) (b = 1.11, P < 0.001) (b = 0.5, P = 0.07)

MAIN FINDINGS

(b = 0.17, P < 0.01) (b = 0.10, P < 0.05)

Mentalizing impairment Neg Symp Childhood Abuse Childhood Abuse Neg Symp

(b = 1.11, P < 0.001) (b = 0.06, P = 0.03)

Mediation: b = 0,07, P < 0,05 One th third of the effect accounted for by im impaired paired menta talizing

Mediation Analysis

Conclusions Conclusions

No No associati tion: : Child Childhood hood abu abuse se to so social cial functi tioning; nor menta talizing to positi tive sympto toms. But: t: § Child Childhood hood abu abuse se may affect negati tive sympto toms in adulthood though im impaired paired menta talizing. . Data support that it is a path thogenic me mecha hani nism sm. . § Mentalization Based Treatment could therefore affect negati tive sympto tomen, which are most debilita tati ting and tr treatm tment t resista tant.