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Studies of gender differences in the sexual activity of men and women after a first acute myocardial infarction (AMI) have produced conflicting results. The present study was performed to determine whether there are gender differences (1) in the quantity and quality of sexual activity after a first AMI, and (2) in the relations between selected demographic and medical variables and sexual activity after AMI. Four hundred sixty-two men and 51 women with a first AMI were interviewed once before discharge and again 3 to 6 months after AMI. Patients' demographic and medical background and their frequency of and satisfaction with sexual behavior were obtained from the interviews and from medical charts. Analyses of variance showed that women reported significantly less frequency of and satisfaction with sexual activity than men before and after AMI. Both women and men reported significantly less sexual activity and less satisfaction with sexual activity after AMI than before AMI. The decrease in frequency of and satisfaction with sexual activity after AMI was similar for women and men. The relations between selected demographic and medical variables such as age, education, and perceived health before the first AMI and the frequency of and satisfaction with sexual activity of the women and men did not appear to be affected differently by the AMI. A first AMI appears to reduce the frequency of and satisfaction with sexual activity of women and men similarly 3 to 6 months after AMI. [ABSTRACT FROM AUTHOR]

Background: Eribulin mesylate is a tubulin inhibitor with activity superior to paclitaxel in NIH:OVCAR-3 human epithelial ovarian cancer xenograft models. In this study, the authors assessed the efficacy of eribulin in platinum-resistant and platinum-sensitive recurrent ovarian cancer.Methods: Patients with recurrent, measurable epithelial ovarian cancer who had received ≤2 prior cytotoxic regimens and who had adequate organ function were enrolled into 2 separate cohorts: 1) platinum-resistant patients (who had a progression-free interval <6 months after their last platinum-based therapy) and 2) platinum-sensitive patients (who had a progression-free interval ≥6 months after their last platinum-based therapy). Eribulin 1.4 mg/m(2) was administered over 15 minutes intravenously on days 1 and 8 every 21 days. Efficacy was determined by objective response on computed tomography studies.Results: In the platinum-resistant cohort, 37 patients enrolled, and 36 patients were evaluable for response and toxicity. Two patients achieved a partial response (5.5%), and 16 patients (44%) had stable disease as their best response. The median progression-free survival was 1.8 months (95% confidence interval, 1.4-2.8 months). In the platinum-sensitive cohort, 37 patients enrolled, and all were evaluable for response. Seven patients achieved a partial response (19%). The median progression-free survival was 4.1 months (95% confidence interval, 2.8-5.8 months). The major toxicity was grade 3 or 4 neutropenia (42% of platinum-resistant patients; 54% of platinum-sensitive patients).Conclusions: Eribulin produced an objective response in 5.5% of women with platinum-resistant, recurrent ovarian cancer and in 19% of women with platinum-sensitive disease. The median progression-free survival was 1.8 months in the platinum-resistant group and 4.1 months in the platinum-sensitive group. [ABSTRACT FROM AUTHOR]

This study describes the construction and preliminary validation of the Israeli Sexual Behavior (ISBI). The ISBI was primarily designed to asses the impact of problems, chronic illness and disability on sexual functioning and experience. Scales were designed to measure three areas of healthy sexual functioning and three areas of sexual dysfunction for both males and females. To provide normative data to which clinical samples can be compared, a large randomly selected sample from an adult male and female population was used for scale construction and preliminary validation. Scale reliabilities, intercorrelations between the ISBI scales, comparisons between the above sample and a clinical sample provide evidence of the ISBI's reliability and validity. [ABSTRACT FROM AUTHOR]

The present study dealt with the attitudes of parents of children with Down syndrome and of family doctors towards reconstructive facial surgery for these children. For both groups, questionnaires were used to measure the attitudes towards the surgery and the basis for the decision to have the surgery performed. In addition, a third questionnaire was administered to the parents to examine their acceptance of the child. No differences were uncovered between the parents and the doctors regarding support for the surgery. However, parents' preferences for physical consequences were greater than for psychological consequences, whereas doctors' preferences did not differentiate between physical, social, and psychological consequences. Parents who showed greater acceptance of their child showed less support for the operation. [ABSTRACT FROM AUTHOR]

We examined the safety and immunogenicity of sequential administration of a tetravalent, non-HLA (human leukocyte antigen) restricted, heteroclitic Wilms' Tumor 1 (WT1) peptide vaccine (galinpepimut-S) with anti-PD-1 (programmed cell death protein 1) nivolumab. This open-label, non-randomized phase I study enrolled patients with WT1-expressing ovarian cancer in second or third remission from June 2016 to July 2017. Therapy included six (every two weeks) subcutaneous inoculations of galinpepimut-S vaccine adjuvanted with Montanide, low-dose subcutaneous sargramostim at the injection site, with intravenous nivolumab over 12 weeks, and up to six additional doses until disease progression or toxicity. One-year progression-free survival (PFS) was correlated to T-cell responses and WT1-specific immunoglobulin (Ig)G levels. Eleven patients were enrolled; seven experienced a grade 1 adverse event, and one experienced a grade ≥3 adverse event considered a dose-limiting toxicity. Ten (91%) of eleven patients had T-cell responses to WT1 peptides. Seven (88%) of eight evaluable patients had IgG against WT1 antigen and full-length protein. In evaluable patients who received >2 treatments of galinpepimut-S and nivolumab, the 1-year PFS rate was 70%. Coadministration of galinpepimut-S and nivolumab demonstrated a tolerable toxicity profile and induced immune responses, as indicated by immunophenotyping and WT1-specific IgG production. Exploratory analysis for efficacy yielded a promising 1-year PFS rate.

Background: To characterize the safety, immunogenicity, and outcomes of patients with high-grade serous ovarian cancer (HGSOC) in second or greater remission treated with a polyvalent antigen-KLH plus OPT-821 vaccine construct and bevacizumab., Methods: Patients with recurrent HGSOC were treated with the vaccine plus bevacizumab at our institution from 01/05/2011 to 03/20/2012. Follow-up continued until 03/2021. Blood/urine samples were collected. "Responders" had an immunogenic response to ≥ 3 antigens; "non-responders" to ≤ 2 antigens., Results: Twenty-one patients were treated on study. One developed a dose-limiting toxicity (grade 4 fever). Two (10%) experienced bevacizumab-related grade 3 hypertension. Thirteen (68%) and 16 (84%) of 19 responded to ≥ 3 and ≥ 2 antigens, respectively (Globo-H, GM2, TF cluster Tn, MUC-1). Four of 21 patients were alive > 5 years post-treatment. Responders and non-responders had a median PFS of 4.9 months (95% CI: 2.8-8.1) and 5.0 months (95% CI: 0.7-cannot estimate), respectively; median OS was 30.7 months (95% CI: 16.9-52.0) and 34.2 months (95% CI: 12.8-cannot estimate), respectively. On two-timepoint analysis (baseline, week 17), increased IL-8 exhibited improved PFS (HR as 10-unit increase, 0.43; p = 0.04); increased PDGF exhibited worse OS (HR as 10-unit increase, 1.01; p = 0.02)., Conclusions: This is the longest follow-up of vaccine administration with bevacizumab in patients with ovarian cancer. The vaccine was well tolerated with bevacizumab. Response was not associated with improved survival. On two-timepoint analysis, increased IL-8 was associated with significant improvement in PFS; increased PDGF with significantly worse OS. For all timepoint measurements, cytokine levels were not significantly associated with survival., Trial Registration: NCT01223235., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: This phase I dose escalation trial evaluated the feasibility of production, safety, maximum tolerated dose, and preliminary efficacy of autologous T cells sensitized with peptides encoding Wilms' tumor protein 1 (WT1) administered alone or following lymphodepleting chemotherapy, in the treatment of patients with recurrent WT1 + ovarian, primary peritoneal, or fallopian tube carcinomas., Methods: A 3+3 dose escalation design was used to determine dose-limiting toxicity (DLT). In cohort I, patients received WT1-sensitized T cells dosed at 5×10 6 /m 2 (level I) without cyclophosphamide lymphodepletion. In cohorts II-IV, patients received lymphodepleting chemotherapy (a single intravenous dose of cyclophosphamide 750 mg/m 2 ), 2 days prior to the first intravenous infusion of WT1-sensitized T cells administered at escalating doses (2×10 7 /m 2 (level II), 5×10 7 /m 2 (level III), and 1×10 8 /m 2 (level IV))., Results: Twelve patients aged 23-72 years, with a median of 7 prior therapies (range 4-14), were treated on the study. No DLT was observed, even at the highest dose level of 1×10 8 /m 2 WT1-sensitized T cells tested. Common adverse events reported were grade 1-2 fatigue, fever, nausea, and headache. Median progression-free survival (PFS) was 1.8 months (95% CI, 0.8 to 2.6); 1 year PFS rate 8.3% (95% CI, 0.5 to 31.1). Median overall survival (OS) was 11.0 months (95% CI, 1.1 to 22.6); OS at 1 year was 41.7% (95% CI, 15.2% to 66.5%). Best response was stable disease in one patient (n=1) and progressive disease in the others (n=11). We observed a transient increase in the frequencies of WT1-specific cytotoxic T lymphocyte precursors (CTLp) in the peripheral blood of 9 of the 12 patients following WT1-sensitized T-cell infusion., Conclusion: We demonstrated the safety of administration of WT1-sensitized T cells and the short-term increase in the WT1 CTLp. However, at the low doses evaluated we did not observe therapeutic activity in recurrent ovarian cancer. In this heavily pretreated population, we encountered challenges in generating sufficient numbers of WT1-reactive cytotoxic T cells. Future studies employing WT1-specific T cells generated from lymphocytes are warranted but should be done earlier in the disease course and prior to intensive myelosuppressive therapy., Trial Registration Number: NCT00562640., One-Sentence Summary: The authors describe the first human application of autologous WT1-sensitized T cells in the treatment of patients with recurrent ovarian, primary peritoneal, and fallopian tube carcinomas., Competing Interests: Competing interests: CK has received research funding from Bristol Myers Squibb, Merus, and Gritstone Oncology. ED and RJOR had consultancy agreements with Atara Biotherapeutics. ED and RJOR are inventors on technology referenced in this work. Proprietary Cell Banks for Use in third-Party WT1-Specific T Cell Therapy; and SK2018-122 (patient ID), Methods of Selecting T Cell Lines for Adoptive Cellular Therapy). Memorial Sloan Kettering Cancer Center (MSK), which owns the technology, has licensed this technology to Atara, and MSK has interests in Atara through this licensing arrangement. AI reports consulting fees from Mylan. CA reports personal fees from Tesaro and Immunogen, grants and personal fees from Clovis, grants from Genentech, AbbVie, AstraZeneca, personal fees from Eisai/Merck, Mersana Therapeutics, Roche/Genentech, Abbvie, AstraZeneca/Merck, and Repare, outside the submitted work. DS is a paid consultant to Repertoire Immune Medicines (Cambridge, Massachusetts, USA). REOC reports personal fees from Tesaro, GlaxoSmithKline, Regeneron, Genentech USA, Fresenius Kabi, Genmab Therapeutics outside the submitted work and is a non-compensated steering committee member for the PRIMA, Moonstone (Tesaro/ GlaxoSmithKline) and DUO-O (AstraZeneca) studies. The remaining authors have no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Challenges in social functioning are a major obstacle in the recovery process of persons with serious mental illness. Majority of social functioning measures use self-report assessments. Aims: To validate the use of a performance based measure and examine a network analysis that explores the centrality of items. In addition, to explore the distinctiveness between the social skills performance assessment (SSPA), and a self-report measure of social quality of life (SQoL). Method: One hundred fifty eight participants were administrated with the SSPA and SQoL scale. Intra-class correlation, Pearson correlation and Network analysis were performed. Results: A differentiation between the SQoL items and the SSPA items appeared. The strongest nodes in the network were social appropriateness (7.413), focus (7.763) and clarity (7.438) from the SSPA measure. The nodes rated highest on the betweenness measure were affect from the SSPA and satisfaction with getting along with other people from the SQoL scale. Conclusions: Interventions should target the skills of focus, clarity and social appropriateness as they present the central items in the network.

Objective: We assessed the safety and maximum tolerated dose (MTD) of the poly ADP-ribose polymerase (PARP) inhibitor olaparib with intravenous (IV)/intraperitoneal (IP) cisplatin/paclitaxel and IV bevacizumab, followed by olaparib and bevacizumab maintenance, in patients with newly diagnosed ovarian cancer who had undergone primary debulking surgery., Methods: Treatment included: (Cycles 1-6) Day 1, IV paclitaxel 135 mg/m 2 /3 h + (from Cycle 2 onward) bevacizumab 15 mg/kg; Day 2, IP cisplatin 75 mg/m 2 ; Days 2-8, olaparib (50/100/200 mg BID); Day 8, IP paclitaxel 60 mg/m 2 of a 21-day cycle. Maintenance (Cycles 7-22) included: olaparib 300 mg BID and bevacizumab 15 mg/kg Day 1. The primary endpoint was MTD of olaparib, chemotherapy, and bevacizumab., Results: Seventeen women were treated (Cohort 1 [50 mg olaparib], 8 patients; Cohort 2 [100 mg], 3 patients; and Cohort 3 [200 mg], 6 patients). Median age was 57 years (47-73); 94% had stage III disease; 29% had a germline BRCA mutation. Two of 6 patients in Cohort 3 experienced a dose-limiting toxicity (DLT). Grade 3/4 toxicities included: neutropenia (56%), lymphopenia (31%), anemia (25%), and fatigue (19%). Most patients started (88%, 81%) and completed (75%, 50%) maintenance olaparib and bevacizumab, respectively; 36% of patients on olaparib maintenance required a dose reduction. Median PFS was 33 months (26.2-NA)., Conclusions: The MTD of intermittently dosed olaparib with concurrent IV/IP cisplatin/paclitaxel and bevacizumab is 100 mg BID. Non-hematologic toxicities were predominantly low grade. One-third of patients on olaparib maintenance required dose reduction., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Previous studies have shown that deficits in social cognition mediate the association between neuro-cognition and functional outcome. Based on these findings, the current study presents an examination of the mediating role of social cognition and includes two different outcomes: social functioning assessed by objective observer and social quality of life assessed by subjective self-report. Instruments measuring different aspects of social cognition, cognitive ability, social functioning and social quality of life were administered to 131 participants who had a diagnosis of a serious mental illness. Results showed that emotion recognition and attributional bias were significant mediators such that cognitive assessment was positively related to both, which in turn, were negatively related to SQoL. While one interpretation of the data suggests that deficits in emotion recognition may serve as a possible defense mechanism, future studies should re-assess this idea., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: Studies have showed that therapists and mental health workers of persons with schizophrenia tend to estimate their patients' social quality of life (SQoL) as poorer than the clients' own estimation. This study explores the hypothesis that this discrepancy is related to clients' social cognition and symptomatology., Design: Cross-sectional assessment of both clients and their mental health workers., Methods: Ninety persons with schizophrenia and 12 persons who were formal care providers participated in the study. All responded to a parallel version (client and clinician) of social quality-of-life scales. Clients' emotion identification, theory of mind and symptoms were also assessed., Results: Low social cognitive abilities of persons with schizophrenia, as well as negative symptomatology and having children, may be related to the negative bias of mental health workers, with regard to their client's SQoL., Conclusions: While more severe levels of negative symptoms and more deficits of social cognition were related to reduced levels of agreement, paradoxically, a relatively normative family life that includes parenting was also related to lower levels of agreement., Practitioner Points: Attention should be given to low agreement between clients with schizophrenia and clinicians with regard to the client's quality of life, as it is central to alliance and outcome. Clinicians tend to estimate clients' social quality of life as poorer than the clients' own estimation when those clients have low social cognition, high negative symptomatology and children. There is a need to identify additional factors that contribute to agreement and alliance in therapy. Longitudinal assessment during therapy can trace the process of construction of agreement., (© 2016 The British Psychological Society.)

Agreement between client and therapist is an essential part of the therapeutic alliance. While there are general challenges to the creation of agreement and shared meaning in all psychotherapies, there are specific challenges while working with persons with psychosis. These challenges include the different narratives of the client and the therapist with regard to their roles and the description of the condition or problem, as well as possible stigmatic views and theoretical bias. Here we present a metacognitive intersubjective model as a framework for the understanding and resolutions of these challenges. Copyright © 2016 John Wiley & Sons, Ltd., Key Practitioner Message: Goal consensus, agreement and shared meaning are essential for a collaborative process and positive outcome in psychotherapy. Challenges to psychotherapy with persons with psychosis include the different narratives of the client and the therapist with regard to their roles and the description of the condition or problem, as well as possible stigmatic views and theoretical bias. In the intersubjective exchange, the concepts of metacognition and empathy can act as a framework for navigating between the possible challenges and the desired shared meaning and agreement., (Copyright © 2016 John Wiley & Sons, Ltd.)

We conducted a phase I study in ovarian cancer patients to evaluate the safety and immunogenicity of a synthetic unimolecular pentavalent carbohydrate vaccine (Globo-H, GM2, sTn, TF, and Tn) supported on a peptide backbone, conjugated to keyhole limpet haemocyanin (KLH), and mixed with immunological adjuvant QS-21. Twenty-four advanced-stage, poor-risk, first-remission ovarian cancer patients were enrolled from January 2011-Septermber 2013. Three dose levels were planned (25, 50, 100 mcg) with three cohorts of six patients each, with an additional 6-patient expansion cohort at the MTD. ELISA serologic IgM and IgG responses for each antigen was defined as positive response if antibody titers were ≥1:80 over the respective patient's pre-vaccination serum. The study would be considered positive if at least four of 12 patients treated at the MTD showed immune responses for at least three of the five antigens. Twenty-four patients (median age, 54 years [range, 36-68]) were included in the safety analysis. Histology was high-grade serous in 22 patients (92%); 18 had stage III and six stage IV disease. The vaccine was well-tolerated at all doses, with no DLTs. At the highest treated dose, IgG and/or IgM responses were recorded against ≥3 antigens in 9/12 patients (75%), ≥4 in 7/12 (58%), and 5 in 3/12 (25%). With a median follow-up of 19 months (range, 2-39), 20 patients (83%) recurred and six (25%) died. The unimolecular pentavalent vaccine construct was shown to be safe and immunogenic. Such a construct greatly simplifies regulatory requirements and manufacturing, facilitates scalability, and provides adaptability.

While some studies view metacognition and social cognition as representing the same phenomenon, others suggest that they represent distinctive sets of abilities that are related to different outcomes. The current study used a cross-sectional design that includes samples of persons with schizophrenia (N=39) and healthy individuals (N=60) to further explore the distinction between social cognition and metacognition and their associations with social quality of life. The Face Emotion Identification Task (FEIT), Faux-Pas Task, Indiana Psychiatric Illness Interview (IPII), Metacognition Assessment Scale - Abbreviated (MAS-A), and Social Quality of Life Scale were administrated to all participants. Correlations, t-tests and regressions were conducted. Results showed that persons with schizophrenia performed more poorly on all measures than healthy controls. Social cognition and metacognition measures were related for the combined total sample, but only a few associations were found among both sub-samples. A diagnosis of schizophrenia and metacognitive capacity, but not social cognition, predicted social quality of life. Self-reflectivity had a negative relationship to social quality of life while understanding of others' minds had a positive relation to social quality of life. The current study provides evidence that many with schizophrenia experience deficits in both social cognition and metacognition and that those deficits may be distinct and have different kinds of relationships with social quality of life. Clinical implications include the need to emphasize narrative aspects of psychotherapy in order to promote metacognition., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Two alternative models of impaired cognitive and affective processing that may underlie reduced social quality of life (SQoL) of persons with schizophrenia, were examined. According to the parallel process model, impaired cognitive empathy and affective empathy make relatively independent contributions to the symptoms of schizophrenia and to the consequent reduction in SQoL. According to the integrative mediation model, the symptoms of schizophrenia and the reduction in SQoL associated with these symptoms are the products of a process by which impairments of cognitive empathy are contingent on impairments of affective empathy. 90 persons with schizophrenia were assessed for SQoL, symptoms and cognitive and affective empathy. Results support the integrative mediation model only for cognitive empathy and negative psychiatric symptoms. Only the negative links between cognitive empathy and negative symptoms served to mediate the positive relation between affective empathy and SQoL. Positive symptoms had a limited negative impact on SQoL and did not play a role in the paths that linked affective empathy to SQoL. Age had a statistically significant and negative indirect relationship to SQoL. Results are consistent with recent approach that distinguish between cognitive and affective empathy and specify how these two processes are integrated., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: Research has shown that attitudes toward different disabilities form a hierarchy, with observers exhibiting more positive attitudes toward persons with physical disabilities than toward persons with psychiatric disabilities. In addition, investigations of attitudes toward persons with a disability indicate that they are often perceived as asexual. The current study examined whether involvement of persons with either a physical or psychiatric disability in a sexual relationship moderates the relation between their type of disability and attitudes toward them., Method: After reading one of six randomly assigned vignettes, university students (N = 195) filled out a semantic differential-based attitude scale (Katz & Shurka, 1977; Kravetz, Katz, & Albez, 1994). The six vignettes consisted of a male with a physical disability/with a psychiatric disability/without a disability, who was either involved/not involved in a sexual relationship., Results: An interaction between type of disability and involvement in a sexual relationship was found for two subscales of the attitudes scale, occupation and intelligence. Involvement in a sexual relationship was found to generate more positive attitudes when the target person had a physical disability but more negative attitudes when he had a psychiatric disability., Conclusions: Involvement in a sexual relationship seems to work in favor of persons with a physical disability because of the association of such a relationship with normality and adaptation. However, attributing such a relationship to persons with a psychiatric disability seems to be stigmatic., ((c) 2014 APA, all rights reserved.)

Objective: The current study examined a mediation model in which symptoms of schizophrenia and schizotypy traits mediate the positive relations between metacognition and Social Quality of Life (SQoL) among persons with schizophrenia and persons without mental illness., Method: 39 persons diagnosed with schizophrenia and 60 persons without a severe mental illness diagnosis participated in this study. Instruments included the Metacognition Assessment Scale-Abbreviated (MAS-A), the SQoL scale of the QLI-MH, the PANSS scale and the O-LIFE self-report questionnaire that assesses schizotypy traits., Results: Persons with schizophrenia exhibit lower SQoL and metacognitive abilities than persons without mental illness. For persons with schizophrenia, negative symptoms mediate the positive relation between the ability to understand other persons' minds and SQoL. However, although for persons without mental illness, understanding other minds was found to correlate negatively with introvertive anhedonia and SQoL, a mediation model was not confirmed., Discussion: Understanding of others' minds seems relevant to the SQoL for both samples. In addition, negative symptoms of schizophrenia and introvertive anedonia traits are also related to SQoL among persons with schizophrenia and among persons without mental illness respectively. The lack of support for a mediation model for persons without mental illness is consistent with the theories that claim schizotypy is not a mirror image of schizophrenia and, therefore, may not necessarily lead to schizophrenia. Limitations of this study and suggestions for future research are discussed.

Chronic combat-related posttraumatic stress disorder (CR-PTSD) is a condition with many treatment barriers. Nature Adventure Rehabilitation (NAR) as a second line or as a supplemental intervention has the potential to overcome some of these barriers and incorporate aspects of successful treatment modalities for PTSD within an experiential learning paradigm. In a pre-post controlled trial, CR-PTSD veterans (n=22) underwent a 1-year NAR intervention compared to a waiting list (WL) control group (n=20). Posttraumatic symptoms (PTS), depression, functional problems, quality of life, perceived control over illness (PCI) and hope were measured by self report measures. PTS, emotional and social quality of life, PCI, hope and functioning improved significantly. Change in PTS was contingent upon change in PCI. The current study is the first to present NAR as a promising supplemental intervention for chronic CR-PTSD. NAR seems to work through a process of behavioral activation, desensitization, gradual exposure to anxiety evoking situations and gaining control over symptomatology., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Many with schizophrenia have been found to experience difficulties recognizing a range of their own mental states including memories and emotions. While there is some evidence that the self perception of empathy in schizophrenia is often at odds with objective observations, little is known about the correlates of rates of concordance between self and rater assessments of empathy for this group. To explore this issue we gathered self and rater assessments of empathy in addition to assessments of emotion recognition using the Bell Lysaker Emotion Recognition Task, insight using the Scale to Assess Unawareness of Mental Disorder, and symptoms using the Positive and Negative Syndrome Scale from 91 adults diagnosed with schizophrenia spectrum disorders. Results revealed that participants with better emotion recognition, better insight, fewer positive symptoms and fewer depressive symptoms produced self ratings of empathy which were more strongly correlated with assessments of empathy performed by raters than participants with greater deficits in these domains. Results suggest that deficits in emotion recognition along with poor insight and higher levels of positive and depressive symptoms may affect the degree of agreement between self and rater assessments of empathy in schizophrenia., (Published by Elsevier Ireland Ltd.)

Research has revealed that approximately one third of persons with a serious mental illness (SMI) experience elevated internalized stigma, which is associated with a large number of negative outcomes. Family members of persons with SMI are also often subject to stigma, but the degree to which these experiences are internalized and lead to self-stigma has rarely been studied. The present study investigated the factor structure of a modification of the Internalized Stigma of Mental Illness (ISMI) scale by Ritsher, Otilingam, and Grajales (Psychiatry Res 121:31-49, 2003). A central assumption of this investigation was that the factor structure of the Parents' Internalized Stigma of Mental Illness (PISMI) scale would be similar to the factor structure of the ISMI scale. A total of 194 parents of persons with SMI completed the PISMI scale. The results revealed that the PISMI scale has high internal consistency and that it is made up of three distinctive factors: discrimination experience, social withdrawal and alienation, and stereotype endorsement. These factors are similar, but not identical, to the factors that underlie the ISMI scale. This study's findings also indicate that parents' prominent reaction to self-stigma is stereotype endorsement.

Most attempts to study the impact of psychosocial interventions on parents of persons with severe mental illness (SMI) are quantitative. The purpose of the present study was to investigate the subjective experience of parents of persons with SMI who participated in either a psychoeducational intervention which emphasized providing information on the illness and support, or a therapeutic alliance focused intervention (TAFI) which emphasized the alliance between the group members and group leaders. Ninety-three parents, who participated in either one of these two interventions, were interviewed using the Narrative Evaluation of Intervention Interview. Results show that participants found both interventions to be beneficial with no statistical differences in the level of perceived change. Themes describing change in relating to illness were significantly more frequently mentioned by participants in the TAFI group, whereas significantly more participants in the family psychoeducation interventions reported that implementation and information provided contributed to positive change. Also participants in the TAFI reported significantly more often that group regulation contributed to change. As both interventions were perceived as contributing, the findings support the relationship orientation to psychosocial interventions, which stresses the quality of the social support and interpersonal interaction as the source of positive outcomes of intervention., (© FPI, Inc.)

This paper uses the framework of the applied social science needs/rights antinomy to describe the efforts of Israel's mental health system in transforming a hospital-based orientation to services for individuals with a severe mental illness, to a community-based recovery orientation. On the one hand, a rationale for the provision of services to individuals with a severe mental illness that stresses these individuals' needs can justify the allocation of society's limited resources by referring to an objectively determinable set of psychiatric needs. However, this rationale may establish an inherent asymmetry between the adequate help provider and deficient help user. On the other hand, a rationale for providing psychiatric rehabilitation services that stresses the fundamental symmetry between the help provider and the help user is empowering, thus consistent with the recovery approach. However, this rationale does not provide a mechanism for negotiating the vague boundary between mental health and mental illness. Israel's mental health system has operationalized a policy that emphasizes rights as well as needs by legislating for a comprehensive set of rehabilitation services that individuals meeting the eligibility criteria may receive. This paper discusses this approach's achievements, challenges and implications for future policy, research, and practice.

This study examined the relationship between insight and mental health consumers and providers agreement regarding consumers rated quality of life (QoL). Seventy mental health consumers and their 23 care providers filled-out parallel questionnaires designed to measure consumer QoL. Consumers' insight was also assessed. For most QoL domains, agreement between consumers and providers was higher for persons with high insight. For the Psychological well being dimension a negative correlation was uncovered for persons with low insight indicating disagreement between consumer and provider. These findings are discussed within the context of the literature on insight and agreement between consumer and provider as related to the therapeutic alliance.

This study compared the effectiveness of a family psychoeducational intervention (FPEI) and a therapeutic alliance focused intervention (TAFI) for parents of daughters and sons with severe mental illness (SMI). A process-outcome model was used to compare the effectiveness of the two interventions and to evaluate how they achieved their outcomes. Extent of effectiveness was assessed in terms of the family burden (FB) of the parents and the quality of life (QoL) and psychiatric symptoms of the daughters and sons. This study did not uncover a difference in effectiveness between the two interventions. However, at post-treatment, the participants in both interventions reported statistically significant less FB and attributed more QoL and less psychiatric symptoms to their daughters and sons than at pre-treatment. In addition, these pre- and post-treatment differences were mediated by specific mediating variables. These results are discussed in terms of the great psychotherapy debate (Wampold, 2001) as to the relative effectiveness of technique oriented interventions as compared to context oriented interventions., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Parents of persons with severe mental illness (SMI) often experience burden due to the illness of their daughter or son. In the present study, the possibility that parents' self-stigma moderates the relationship between the parents' insight into a daughter's or son's illness and the parents' sense of burden was investigated., Methods: Levels of insight into a daughter's or son's mental illness, parent self-stigma, and parent burden of 127 parents of persons with an SMI were assessed. Regression analysis was used to test the putative moderating role of parents' self-stigma., Results: Self-stigma was found to mediate rather than moderate the relationship between insight and burden. Accordingly, parent insight into the mental illness of a daughter or son appears to increase parent burden because it increases parent self-stigma., Conclusions: The implications of these findings for practice, theory, and future research are discussed., (© 2011 Elsevier Inc. All rights reserved.)

Controversy exists as to the cognitive, emotional and behavioral consequences of lack of insight for persons with schizophrenia. This study tested a mediation model of the relations between insight into mental illness, hope, and the aspects of quality of life of persons with schizophrenia. According to this model, insight into mental illness may impact negatively on the quality of life of persons with schizophrenia by reducing these persons' hope. Sixty persons with schizophrenia or schizoaffective disorder completed questionnaires that assessed their insight, quality of life, and hope. The study's results show that for six of seven aspects of quality of life and for general awareness of illness, the above-hypothesized mediation model was confirmed. These results suggest that increasing the hope of persons with schizophrenia may directly and positively increase both their quality of life and the usefulness of their insight into their illness.

Background: Illness Management and Recovery (IMR) is a standardized curriculum-based intervention to help people with serious mental illnesses acquire knowledge and skills to manage their illnesses effectively and achieve personal recovery goals. Recent evaluations of IMR have shown promising results with regard to feasibility and effectiveness., Objectives: The aim of the present study was to investigate and describe (1) whether participants perceived IMR as effective a year after completion, (2) if so, in what domains did they experience the IMR program to be beneficial, and, (3) in what ways did the IMR program differ from prior rehabilitation interventions they had experienced., Method: 36 people with serious mental illnesses completed the Narrative Evaluation of Intervention Interview (NEII), a year after completing IMR. Qualitative analysis of the interviews involved two judges independently identifying themes. Inter-rater reliability ranged from .63 to 1.00., Results: Participants reported high levels of perceived helpfulness. Three domains of improvement attributed to IMR included cognition, coping, and social support. With regard to the uniqueness of the IMR intervention, five categories emerged: Learning new information, social support, coping and self management, program structure, and message of hope., Conclusions: The positive impact of IMR reported in previous studies lasts as long as a year. Domains of reported improvement partially overlap with outcomes reported in previous studies. IMR is perceived to differ in several ways from other psychiatric rehabilitation interventions, both in technique as well as in message.

Communication and interpersonal deficits are major stumbling blocks that stand between persons with severe mental illness (SMI) and such recovery goals as quality of life (QoL) and community integration. Not only do these deficts have a direct and negative impact on the QoL and community integration of persons with SMI but they also may reduce these persons' ability to take advantage of major interventions in which communication and interpersonal relationships play a central role (i.e., psychotherapy, recovery programs, illness management and recovery). Recent theories of schizophrenia and other SMI attribute these communication and interpersonal limitations of persons with SMI to impairments of metacognition (i.e., empathy, theory of mind [ToM], mind reading). Within a dialogical framework of metacognition that differentiates between empathy and ToM, this paper reviews two interventions for persons with SMI, Metacognitive Training (MCT) and Social Cognition and Integration Training (SCIT), that were recently developed to improve communication and interpersonal skills of persons with schizophrenia. These interventions are based on the above described theories of schizophrenia and SMI. Although preliminary research has produced favorable results for these interventions, additional investigations using more critical research designs are required to establish their efficacy. Furthermore, this paper suggests that adding dialogical elements to these interventions might improve their effectiveness.

The present study examined the psychometric properties of the clinician and client versions of the Illness Management and Recovery (IMR) scale. Using a 5-point behaviorally anchored response format, these scales were designed to tap the critical illness management and recovery domains targeted by the IMR program. This program is a curriculum-based approach to helping persons with a serious mental illness (SMI) acquire the knowledge and skills they need to manage their illness effectively and to achieve personal recovery goals. Two hundred and ten persons with a diagnosis of a SMI and their 13 clinicians filled-out the client and clinician versions of the IMR questionnaire. The clients also responded to measures of coping efficacy and social support. While indicating limitations of the IMR scales and pointing to how they could be improved, this study provided some support for the construct and concurrent validity of the client and clinician versions of the IMR questionnaire. Moderate reliabilities were uncovered for these parallel versions of the questionnaire. Client responses to the client IMR scale and clinician responses to the clinician IMR scale were shown to be characterized by similar major components of the IMR intervention.

Objective: This study evaluated the effectiveness of the Illness Management and Recovery program implemented in a group format., Methods: A total of 210 persons with a severe mental illness receiving treatment at rehabilitation centers in the community in Israel were randomly assigned to either the Illness Management and Recovery program or treatment as usual. The Illness Management and Recovery Scale (client and clinician versions) and measures of coping and social support were administered to participants before and after the intervention., Results: Participants in the Illness Management and Recovery program showed significant improvement in knowledge about their illness and progress toward their personal goals compared with those receiving treatment as usual. Clinician ratings also indicated significant improvement in overall outcome for clients in the Illness Management and Recovery program compared with those who received treatment as usual. Significant improvement in coping was found in both groups, and no change in social support was found for either group., Conclusions: The Illness Management and Recovery program was effective in increasing clients' knowledge of their illness and helping them make progress toward personal goals.

Major recent conceptual and legal advancements in Israel have generated a profound shift in the services provided for people with severe mental illness. Perhaps the most influential development has been the passage of the act for the rehabilitation of persons with a psychiatric disability in the community in the year 2000. In this paper we argue that the psychiatric rehabilitation services defined by the recent legislation lack explicit standards or criteria for selection, and thus could benefit from incorporating interventions that evidence has shown to be effective in assisting clients to achieve desirable outcomes. We propose a practical five-step plan to facilitate the implementation of these evidence-based practices including creating demand, selecting the EBPs, preparing practitioners and agencies, monitoring and feedback, and ensuring sustainability. The importance of an ongoing dialogue between stakeholders to facilitate the integration of research evidence, clinical expertise and rehabilitation values to improve the quality of service is discussed.

Background: Insight into having a psychotic disorder is often considered to be a positive characteristic that improves quality of life. However, the evidence regarding this controversy is mixed. The present study examined the relation between insight and quality of life., Method: One hundred thirty-one participants with a psychotic disorder (103 with schizophrenia, 28 with schizoaffective disorder) underwent an assessment of insight, psychotic symptoms, and quality of life. The relation between insight and quality of life was assessed using regression analyses., Results: Contrary to our hypothesis, better insight into having a psychotic disorder was related to reduced emotional well-being (beta = .23, P < .01), lower vocational status (beta = .31, P < .01), and less economic satisfaction (beta = .27, P < .01). Insight into the need for taking medication was positively correlated with higher emotional well-being (beta = -.18, P < .05). No relation was found between insight and psychotic symptoms., Discussion: In light of our findings, the potential importance of combining insight with mechanisms for coping is discussed.

Studies have been carried out to explore the impact of sense of control on the outcome of persons with severe mental illness (SMI). However, few studies have compared the differential effects of perceived personal control (control of the self) and perceived interpersonal control (the control of significant others). In the present study, we investigated the relations between perceived personal and perceived interpersonal control and different domains of quality of life (QOL) of persons with SMI. Measures of perceived personal and interpersonal control and QOL were administered to 145 participants with a diagnosis of SMI (schizophrenia, affective disorders, anxiety disorders, personality disorders). The results showed personal control to be positively related to various domains of QOL (beta = .28-.31, p < 0.001-0.01) while interpersonal control was negatively related to the physical domain of QOL (beta= -.20, p < 0.05). Theoretical, empirical, and clinical implications of the distinction between personal and interpersonal control for persons with SMI are discussed.

Primary Objective: To examine the moderating effect of wives' coping flexibility on the relation between time since husband's traumatic brain injury (TBI) and wives' perceived burden and the hypotheses that wives of long duration TBI men and wives with less coping flexibility will express more burden than wives of short duration burden men and wives with more coping flexibility., Research Design: Forty-four wives whose husbands had sustained brain injury were interviewed 1 year or more after hospital discharge., Methods and Procedures: The Relatives' Burden Questionnaire and Ways of Coping Questionnaire for each of four different problem vignettes were administered to the wives., Main Findings and Conclusions: No statistically significant effects were found for TBI duration or for wives' coping flexibility, although longer duration TBI wives reported a statistically significant higher level of burden than short duration TBI wives, only if the wives were characterized by low coping flexibility.

In a community cohort of 833 women and men aged <60 years, employed at the time of a first acute myocardial infarction (AMI), the relation of sociodemographic, vocational, and medical variables to the following three aspects of employment was investigated longitudinally: resumption of employment anytime within 5 years after AMI, resumption of employment within 3 months of the AMI, and maintenance of employment 5 years after AMI. Different sets of characteristics of persons with a first AMI were related to the different criteria of employment. Only sociodemographic and vocational variables were related to early resumption of employment, whereas maintenance of employment 5 years after AMI was influenced by both medical and nonmedical variables. These results support the importance of examining different aspects of resumption and maintenance of employment after AMI. They also suggest that early resumption of employment after AMI and employment anytime 5 years after AMI are more a function of the sociodemographic and vocational characteristics of the person with the AMI than of that person's medical condition, whereas long-term maintenance of employment after an AMI is also related to the person's medical condition., (Copyright (c) 2005 S. Karger AG, Basel.)

The work histories of persons with severe and persistent psychiatric disabilities are generally characterized by sporadic employment interspersed with long periods of unemployment during which they are supported by and often become dependent upon such forms of public aid as SSI or SSDI. This paper first describes a multifaceted work participation approach to employment and career building. It then explores the implications that this approach has for establishing future directions for research and interventions aimed at improving the quantity and quality of the participation in the work life domain of persons with a psychiatric disability.

Objectives: To compare the long-term psychologic well-being and psychologic distress, after a first acute myocardial infarction (AMI), of women with those of men and those of a normative community sample of women and to examine the relation of sociodemographic, medical, and psychologic variables to the long-term psychologic well-being and psychologic distress of women., Design: Longitudinal study., Setting: Eight medical centers in central Israel., Participants: Sixty-two women (age range, 30-65y) with documented first AMI., Interventions: Sociodemographic, medical, and psychologic data were collected before hospital discharge (T1). Psychologic well-being and psychologic distress were assessed 5 years after AMI (T2) with the Mental Health Inventory., Main Outcome Measures: Hierarchical regression was used to examine the relations among the outcome variables, psychologic well-being, and psychologic distress at T2 and the predictors, sociodemographic, medical, and psychologic variables at T1., Results: Women had less long-term psychologic well-being and more psychologic distress after AMI than did men or the normative sample of women. Depression and concomitant medical problems were related to women's psychologic well-being; depression alone was related to their long-term psychologic distress., Conclusions: Women with an AMI are more likely than men to have reduced psychologic well-being and increased psychologic distress. In addition, diminished mental health was related to medical and psychologic pathogenic factors.

Many people with a psychiatric disability appear to exhibit varying degrees of lack of awareness of the mental disorder that is implied by their diagnosis. Furthermore, there is considerable controversy regarding the significance of being aware of and acknowledging a psychiatric disorder. Different responses to the issues underlying this controversy can be found in the professional and research literature. This article describes and compares some of these responses. On the basis of this description and comparison, a multifunctional narrative approach to insight into mental disorder is developed, and implications of this approach for psychiatric rehabilitation research and for psychiatric rehabilitation intervention are explored.

Objective: To evaluate the differential and independent impact of sociodemographic, medical, and psychologic variables assessed at hospital discharge on patients' short- and long-term mental health., Design: Longitudinal study., Setting: Eight medical centers in central Israel., Participants: Male Israeli patients (N = 209; age range: 30-65 y) with documented first acute myocardial infarction (AMI)., Intervention: Subjects were interviewed 3 times, once (T1) before hospital discharge, a second time (T2) at 3 to 6 months after discharge, and a third time (T3) at 5 years post-AMI. Sociodemographic, medical, and psychologic data were elicited at the first interview and completed with medical information in the files. Psychologic well-being and psychologic distress were evaluated by the Mental Health Inventory at the second and third interviews. These 2 outcome variables were compared with normative community data on these aspects of mental health., Main Outcome Measures: Hierarchical regression was used to examine the relation between the independent variables, sociodemographic, medical, and psychologic variables, and the dependent variables, psychologic well-being and psychologic distress, at T2 and T3., Results: Depression, perceived health, sense of coherence, social support, and educational level at discharge predicted aspects of mental health 3 to 6 months and 5 years post-AMI. However, only psychologic distress differentiated between the research participants and the normative community sample of men., Conclusions: A first episode of AMI appears to increase psychologic distress more than it decreases psychologic well-being both 3 to 6 months and 5 years post-AMI. Educational level and sense of coherence may serve as protective factors, whereas depression may foster vulnerability to distress and impaired psychologic well-being., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

Agreement on care consumer quality of life (QOL) in different life domains between persons with a psychiatric disability and their care providers was examined. The former persons tended to report higher QOL than their care providers and care providers and care consumers evinced limited agreement on actual care consumers' QOL and on the substance of care consumer QOL Care providers' confidence in their judgment of care consumer QOL, but not duration of care provider-care consumer contact, was associated with more care provider-care consumer agreement. Thus, ways of increasing care providers' understanding of care consumers' perceptions of problems and goals should be investigated.

The effect of sentence context on the processing of different aspects of meaning of unambiguous nouns by the two cerebral hemispheres was examined. Participants performed a lexical decision task on target words following two primes, an unambiguous noun preceded by an incomplete sentence. Priming sentences were consistent with either the dominant or the subordinate aspect of meaning of their final unambiguous word. Short and long SOAs were used. A principal finding of this study was that, when compared to unrelated aspects of meaning, for both the short and the long SOAs, the dominant and subordinate aspects of meaning of the unambiguous words were activated regardless of context in both hemispheres. However, the activation of the subordinate aspect of meaning of unambiguous words appears to be more sensitive to sentential context, especially when the unambiguous word is being processed by the left hemisphere., (Copyright 2002 Elsevier Science (USA).)

A decrease in sexual activity after an acute myocardial infarction (AMI) for both women and men has been reported with one study suggesting that this reduction in sexual activity may precede rather than proceed the AMI. The present study compared the sexual activity of women and men before AMI to the sexual activity of a normative community sample of women and men, to examine whether the above reduction in sexual activity is especially characteristic of women and men who later incur an AMI. This study also investigated the association between selected medical and sociodemographic variables and sexual inactivity of women and men before an AMI. During an interview before discharge,138 women and 760 men who were hospitalized due to a first AMI responded to a question regarding the frequency of their sexual activity 1 year before the AMI. Their sociodemographic and medical background was obtained from the interview and the medical charts. When compared to a normative sample, only women reported significantly less sexual activity during the year before their AMI. These women were also found to be at a disadvantage when compared to men on many of the sociodemographic and medical variables shown to contribute to sexual inactivity for both men and women. However, the higher percent of sexual inactivity for women during the year before AMI may not only be due to women's higher morbidity and lower sociodemographic status. Other variables not included in this study, but associated with gender, could account for this result., (Copyright 2002 S. Karger AG, Basel)