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The Essay on Man is a philosophical poem, written, characteristically, it is in fact a fragment of a larger work which Pope planned but did not live to complete.

All potential participants received an invitation with basic information about the study and what would be required of them. They were also asked to provide demographic and professional data. Of the 1, health professionals who agreed to take part and who provided demographic and professional data, were psychologists who met the eligibility criteria and who were therefore invited to begin round one of this study. A total of psychologists from 46 countries covering the six WHO regions answered the first-round survey They primarily worked in clinical practice mean The second-round survey was answered by psychologists, and completed the third round, with a response rate across rounds one to three of There were no statistically significant differences in age, gender, or population treated urban, rural, acute, and chronic between psychologists who responded in the first round and those were invited to take part but did not do so.

There were no significant differences in age, gender, or years of experience in treating individuals with schizophrenia between the groups that responded across rounds 1 to 3. With the aim of avoiding language barriers and encouraging participation by experts from different world regions, the study was conducted in five languages Chinese, English, French, Russian, and Spanish.

The survey materials were independently translated and supervised by at least two native speakers.

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The Delphi process is shown in Fig 2. Data were collected between March and June , with participants being allowed two weeks to respond in each round. Responses in the first Delphi round were logged using an online survey system www. Participants were sent an e-mail with a link to the survey homepage and instructions i. To help them with this survey they were asked to consider six open-ended questions that covered all four components of the ICF-CS; the Environmental factors component was divided into supportive and hindering factors survey questions can be consulted in S1 Text.

The expected completion time for each survey round was about 15 minutes. The responses gathered in the first round were then linked to ICF categories using established ICF linking rules [ 16 , 17 ]. Specifically, all the panelists who had responded in the first round were sent a list of the selected ICF categories linked to the responses of all participants, as well as a list of the categories proposed for Personal factors , along with their respective definitions.

They were reminded that the aim was to obtain a final list that was both short enough to be applicable in clinical practice and sufficiently comprehensive to cover the most important needs of people with schizophrenia.

Schizophrenia Overview - Clinical Presentation

Participants in the third round were asked to evaluate the same list of categories again, this time taking into account the feedback they were sent concerning the responses of the panel and their own previous responses. All components of the ICF, except Personal factors , are organized hierarchically in an exhaustive list of categories see Fig 3. Third- and fourth-level categories are more specific than second-level categories, and they share the attributes of the second-level category with which they are associated.

Therefore, their use implies that the corresponding second-level category is applicable. Two health professionals with experience of treating persons with schizophrenia and trained in the use of the ICF independently linked all responses from the first Delphi round to the corresponding ICF categories. Any disagreements between the two independent coders were reviewed and discussed by two other health professionals with the aim of achieving consensus. Personal traits that constitute a premorbid predisposition of individuals and which affect how they cope with their illness were considered as Personal factors , whereas personality traits that are altered due to the illness were coded under category b of Body functions.

However, as they are relevant to assessment and intervention planning, concepts related to Personal factors were summarized and considered in rounds two and three of the Delphi study. The proposed categorization of Personal factors was developed by consensus among three psychologists L. We calculated descriptive statistics for the sociodemographic characteristics of participants and the frequencies of ICF categories.

In order to be able to compare our findings with the ICF-CSs for schizophrenia, which comprise solely second-level categories, all third- and fourth-level categories identified in the Delphi process were aggregated to their corresponding second-level category. The categories for which there was agreement in the third round were compared with the categories included in both the Brief and Comprehensive ICF-CSs. Fifty-three categories were proposed for the Personal factors identified. Aggregation of third- and fourth-level categories to their corresponding second-level category yielded a list of second-level ICF categories.

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This meant that in round two, the panel had to consider a list of second-level ICF categories and 33 Personal factors. In the third round, consensus i. Data regarding the categories presented to experts in rounds two and three and the degree of consensus reached are shown in the first two rows of Table 2.

Applying the delta statistic method, a general index of. The kappa coefficient for the linking process was. A summary of the results is shown in the third and fourth row of Table 2. More detail regarding the categories listed by the experts and the corresponding percentage analyses is provided in S1 — S5 Tables. Table 3 lists the categories that did not match in the two sets of data the set of categories included in the ICF-CS for schizophrenia and the set of categories that reached consensus. Four of the 17 categories that are included in the ICF-CS for schizophrenia b Fluency and rhythm of speech functions , b Weight maintenance functions , b Sexual functions , and b Involuntary movement functions did not achieve consensus in the Delphi study see S1 Table for more details.

Regarding the Body structures component, the ICF-CS for schizophrenia does not contain any category from this component. Sixteen categories from this component that are included in the ICF-CS for schizophrenia did not yield consensus see S3 Table for more information. Regarding Personal factors , which are not classified in the ICF, 33 concepts were presented to the experts, and 28 of these yielded consensus see S5 Table. This validation study highlights the functioning-related issues that psychologists encounter in their work with individuals with schizophrenia and considers the extent to which these aspects are covered by the ICF Core Sets for schizophrenia.

We will therefore focus on comparing our results with the categories featured in the Comprehensive ICF-CS for schizophrenia.

Concerning the Body functions component, all the categories that yielded consensus belong to chapter b1 Mental functions. Some of the categories that achieved higher consensus refer to cognitive functions, such as b Higher-level cognitive functions. This area is one of the main targets of psychological interventions such as cognitive remediation therapy CRT , which aims to improve neurocognition and other functional outcomes in individuals with schizophrenia [ 23 ].

Psychological interventions also address other categories that were associated with high agreement, namely psychosocial functions b Global psychosocial functions [ 24 ] , functions affected by negative symptoms e. These results differ slightly from those obtained from the perspective of psychiatrists [ 14 ]. Although psychiatrists highlighted the importance of many categories from chapter b1 Mental functions , they also emphasized other categories from the Body functions component, such as b Weight maintenance functions or b Involuntary movement functions.

This is consistent with the more biomedical perspective of psychiatrists. As this category also reached consensus in the validation study from the perspective of psychiatrists it clearly reflects a problem area for these patients [ 28 , 29 ], and therefore its exclusion from the ICF-CS for schizophrenia should be reconsidered.

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In fact, these functions are mainly assessed by other professionals, such as endocrinologists weight maintenance or physiotherapists movement abnormalities. The literature also supports the idea that the brain is the main altered structure in this illness and it is considered to be the basis of other dysfunctions such as neuropsychological impairment [ 30 ]. There is also evidence that psychological interventions produce changes in brain structure and its functioning [ 31 ], with this being the goal of interventions such as cognitive remediation. Thus, from the perspective of psychologists, inclusion of this category in the ICF-CS for schizophrenia should be considered.

The component with the largest number of categories achieving consensus was Activities and Participation. These categories covered all its chapters and focused especially on learning and applying knowledge e.

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Schizophrenia: Update on Treatment Options

Once again, these results are consistent with those obtained in the validation of the ICF-CS for schizophrenia from the perspective of psychiatrists. All categories of the Activities and Participation component for which consensus was reached are listed in the ICF-CS for schizophrenia. Sixteen categories that are included in the Activities and Participation component of the Comprehensive ICF-CS for schizophrenia were initially referred to by many of our experts but did not reach the threshold for consensus.

Of these, the ambiguous categories i. These results offer a more positive view of the abilities of people with schizophrenia, since it suggests that their difficulties mainly depend on the complexity of the task. The agreed-upon categories especially concerned support and relationships e. These results suggest that psychologists ascribe considerable importance to the impact of environmental factors on the functioning of a person with schizophrenia, a point already made by other authors [ 34 , 35 ].

Of the 29 categories from this component that yielded consensus in the Delphi study, only one i. This category belongs to chapter e1 Products and Technology , and it should be noted that the ICF-CS for schizophrenia already contains four categories from the same chapter i. Given that an ICF-CS needs to be as short as possible, this domain may already be sufficiently covered by these four categories. This suggests that these categories e. Concerning the Personal factors component, we drew up a proposed list of 33 personal factors, 28 of which achieved consensus in the third Delphi round.

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This level of agreement supports the relevance of personal factors to the assessment and treatment of individuals with schizophrenia. Personal factors, such as resilience [ 36 , 37 ], premorbid cognitive skills [ 38 ], premorbid social skills [ 39 ], personal history and biography [ 40 ], premorbid drug use and lifestyle [ 41 ], and premorbid personality [ 42 ] have been considered to influence how people with schizophrenia cope with their illness.

Most of the categories that psychologists regarded as important coincide with those identified in the validation study from the perspective of psychiatrists [ 14 ], suggesting that the proposed list of Personal factors captures the aspects that merit particular consideration in this population.

This is likely due to the multidisciplinary approach that was used to develop this ICF-CS, which aims to cover the main intervention targets not merely of a specific professional group in this case, psychologists but of all health professionals involved in the treatment of individuals with schizophrenia [ 11 ].

A particular strength of the present study is that the panel of experts comprised psychologists from 46 countries covering all six WHO regions. Such a large sample is not common in this kind of study [ 44 , 45 ]. Furthermore, all the experts surveyed had considerable experience Another strength of the study is that participation was possible in any of five languages, and this is likely to have been a key factor in achieving such a multicultural and multinational representation.

The primary limitation of the study concerns the representativeness of the panel of experts. Although psychologists from all over the world took part, the Eastern Mediterranean, Western Pacific, and African WHO regions were under-represented, and this may limit the external validity of our results. Possible reasons for this under-representation include limited internet access and lower numbers of psychologists in these regions.


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To conclude, the results of this study provide strong support for the content validity of the Comprehensive ICF-CSs for schizophrenia as they were obtained by surveying psychologists from all six WHO regions. The present study investigated whether seeing schizophrenia as a genetic or environmental disorder might influence perceived beliefs towards people with schizophrenia and whether social stigmatizing attitudes were differently perceived the subjects who were recruited.

Perceived social stigmatizing attitudes were compared among participants who read two vignettes depicting a person with schizophrenia. A genetic explanation of schizophrenia was more frequently associated with stigmatizing attitudes. Also, there were higher levels of perceived stigmatization in medical students and medical doctors than in other groups based on their social experience or background.

About half of the participants perceived stigmatizing social attitudes. Finally, considering schizophrenia as a genetic disorder influenced participants perception of other people's beliefs about dangerousness and unpredictability and people's desire for social distance. Volume 18 , Issue 7. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.

If the address matches an existing account you will receive an email with instructions to retrieve your username. Journal of Psychiatric and Mental Health Nursing. Read the full text. The interview was recorded and transcribed. The content reported by the patient was subjected to thematic content analysis: 1 skim reading; 2 highlighting of the nuclei of meaning; 3 identification of the themes; and 4 definition of the categories.