Integrated versus sealed-over recovery in schizophrenia - BORRTI and executive function

Department of Psychiatry, Yale University, New Haven, Connecticut, United States
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 02/2005; 193(1):3-8. DOI: 10.1097/01.nmd.0000149212.94261.1e
Source: PubMed


Ego functioning of 222 outpatients with a diagnosis of schizophrenia or schizoaffective disorder was evaluated using the Bell Object Relations and Reality Testing Inventory (BORRTI). Sixty-one of these had BORRTI profiles identified as sealed-over recovery style, and 36 had profiles interpreted as integrated recovery style. Groups were compared on demographic characteristics, symptom profiles, and the Wisconsin Card Sorting Test, a performance measure of executive function. Groups had comparably low levels of positive symptoms, but the integrated recovery group had higher scores on the BORRTI uncertainty of perception scale. The integrated recovery group had significantly fewer minority patients, higher IQ, and higher levels of emotional discomfort. The sealed-over recovery group had higher levels of cognitive disorganization. When differences in ethnicity and IQ were controlled for, the integrated recovery group had better executive functioning. Wisconsin Card Sorting Test categories completed emerged as the significant predictor in a logistic regression, explaining 19% of the variance. These findings support the discriminant validity of these two recovery styles and reveal the importance of executive function in a recovery style that allows for investment in relationships, affect tolerance, and acknowledgment of symptoms.

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    • "The most severe disturbances in object relations are usually found among patients with borderline personality disorder [20]. Patients with schizophrenia appear to have significantly more deficits in object relations compared to healthy controls [21] [22] and more disturbances in reality testing compared to other clinical groups [23] [24] [25]. However, no studies have, to our knowledge, specifically investigated these aspects in patients with bipolar disorder. "
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    ABSTRACT: OBJECTIVE: Deficits in object relations (OR) and reality testing (RT) functions are found in schizophrenia but have never been investigated in bipolar disorder. In the current study, we examine if there are OR and RT differences in schizophrenia and bipolar disorder compared to healthy controls and to what extent differences in clinical characteristics mediates the putative effect of diagnosis. METHODS: We used the Bell Object Relation and Reality Testing Inventory (BORRTI) to measure OR and RT in schizophrenia (n = 55), bipolar disorder (n = 51) and healthy controls (n = 158). Diagnoses and the life time presence of psychotic symptoms were evaluated based on the Structured Clinical Interview for DSM-IV. We used the Positive And Negative Symptom Scale to measure current symptoms. RESULTS: Analyses of variance with post hoc tests showed statistically significant differences in OR and RT between the Schizophrenia (SCZ), Bipolar Disorder (BD), and Healthy Control (HC) groups. Multiple regression analyses indicated that a lifetime history of psychotic symptoms contributed significantly to the variance in one BORRTI subscale (Social Incompetence) while Positive And Negative Symptom Scale components (either the positive component and emotional discomfort component) contributed significantly to the variance in all BORRTI subscales except one (Uncertainty of Perception). CONCLUSIONS: OR and RT deficits are present both in SCZ and BD, but differences appears to be mediated by differences in current positive and depressive symptoms.
    Comprehensive psychiatry 05/2012; 53(8). DOI:10.1016/j.comppsych.2012.04.003 · 2.25 Impact Factor
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    • "This finding is in line with other studies that have shown the bearing of a patient's recovery style on their engagement with treatment and their recovery from psychosis (McGlashan, 1987; Tait et al., 2003; Thompson et al., 2003). It seems that an integrating recovery style allows patients to invest in relationships, tolerate affective states, and acknowledge symptoms (Bell and Zito, 2005) and that this may be crucial for engaging effectively with treatment, achieving sustainable symptom remission, and constructively adapting one's life after a psychotic episode. Some studies have found that remission in schizophrenia was predicted by a patient's having intimate relations, being married (Bankole et al., 2008; Emsley et al., 2006), and lacking lifetime traumatic events (Bankole et al., 2008). "
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    ABSTRACT: Although people with schizophrenia use various coping strategies, it is largely unknown how their coping style contributes to remission of the illness. The concept of recovery style-either by sealing over or integrating-reflects an important distinction. We wanted to examine whether recovery style predicts remission at a 1-year follow-up. We examined the recovery style, insight, therapeutic alliance, and symptoms in 103 patients with psychotic disorders. To assess the remission status, the symptoms were measured at 6 and 12 months. Logistic regression analyses were used. Results showed that scoring an extra category toward integration (six categories exist) increased the odds of remission 1.84-fold (95% confidence interval, 1.11 to 3.03). Insight and therapeutic alliance were not predictive. Although remission was also predicted by positive symptom levels at baseline, this did not influence the effect of recovery style. In conclusion, independently of symptom levels, insight, or therapeutic alliance, an integrating recovery style increases the odds of remission at a 1-year follow-up.
    The Journal of nervous and mental disease 05/2011; 199(5):295-300. DOI:10.1097/NMD.0b013e3182174e97 · 1.69 Impact Factor
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    • "In support of this possibility are studies suggesting that persons with schizophrenia who deny rather than acknowledge that they are ill perform especially poorly on neurocognitive tests of executive function (Drake and Lewis, 2003; Lysaker et al., 2003; Smith et al., 2000; Young et al., 1998). Other studies have linked an integrated self-understanding (Bell and Zito, 2005) and better abilities to think about one's own thoughts and the thoughts of others with better performance on executive function tests (Greig et al., 2004; Lysaker et al., 2005, 2007b). Also supporting this contention are studies of young children which suggest that executive functions emerge before, and are a basis for, the ability to think about the mental states of others (Moses, 2005). "
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    ABSTRACT: Deficits in metacognitive capacity, or the abilities to think about thinking, are thought to be a key barrier to functioning in schizophrenia. Although metacognitive function may be linked to executive function, it is unclear how the different domains of each phenomenon are related to one another. Accordingly, we assessed 4 domains of metacognition on the basis of a self-generated narrative using the Metacognition Assessment Scale. These were correlated with subtests of the Delis Kaplan Executive Function System which assessed 2 domains of executive function: mental flexibility and inhibition. Participants were 49 men with schizophrenia spectrum disorders in a postacute phase of illness. Spearman Rho correlations revealed awareness of one's thoughts and feelings were more closely linked to performance on tests which required mental flexibility while recognizing others' needs, and independent relationships were more closely linked to performance on tasks which required inhibitory control. Results suggest different domains of metacognition may be influenced by and influence different neurocognitive processes.
    The Journal of nervous and mental disease 06/2008; 196(5):384-9. DOI:10.1097/NMD.0b013e3181710916 · 1.69 Impact Factor
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