First person account: where did I go?

Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis

BACKGROUND AND OBJECTIVE

Experiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature.

METHODS

Electronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis.

RESULTS

Of 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss.

CONCLUSIONS

Our conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.

A Literature Review on the Experience of Long-Term Mental Illness

PURPOSE

To illuminate long-term experiences of mental illness from both research and autobiographical accounts.

DESIGN

A literature review of English-language papers, 1950-2014, relating to the experience of long-term mental illness indexed in AgeInfo, AMED, ASSIA, British Nursing Index (BNI), CINAHL, MEDLINE, PsycEXTRA, and PsychINFO.

FINDINGS

Twenty-five research papers and nine autobiographic accounts met the review criteria. Thematic analysis revealed nine themes: fear, explanation seeking, stigma, disability, coping strategies, control, support, change and learning, and life history. Specific gaps of note relate to age differences, acknowledgement of longevity of mental illnesses, and different cultural perspectives. Research Implications: There is an absence of longitudinal studies focused on experiences of long-term mental illness. The considerable length-of-time implicated in the experiences suggests that more individual life experience rather than illness focused studies are needed, enabling a holistic understanding. This includes studies from cultures other than the Western world. Greater transparency is needed in justifying age inclusions or passive exclusion of older peoples' perspectives.

PRACTICAL IMPLICATIONS

Knowledge of long-term mental illness experiences is of great importance to mental health practitioners. Evidence-based services cannot be provided if we do not have an holistic understanding of long-term mental illness. Social Implications: This review questions our ability to provide effective support for those experiencing long-term mental illness, in particular older people and different cultural perspectives.

ORIGINALITY/VALUE

There appear to be no literature reviews that focus on the individual experience of long-term mental illness. It highlights the surprisingly small number of research studies available to inform mental health practitioners.

First-person accounts of delusions

Aims and Method

In order to investigate cognitive aspects of the experience of delusions, including onset and recovery, autobiographical accounts of schizophrenia were reviewed.

Results

The sample was self-selected and biased towards women and highly-educated patients. The delusions described were usually gradual in onset and often occurred in the context of an odd or fearful mood, which was accompanied by distorted reasoning. Recovery was also gradual with an intermediate stage of reality-testing or fluctuation between belief and disbelief. Many patients retained residual aspects of delusional thinking after recovery. Most attributed their recovery to a combination of medication, psychotherapy, social support and personal coping strategies; some felt that their illness had enhanced their self-awareness or spirituality.

Clinical Implications

Further exploration of spontaneous coping strategies in recovery from delusions through personal accounts of illness would be valuable.

Coping Tactics and the Management of Acutely Distressed Schizophrenic Patients

Two patients with florid symptoms and severely disturbed behaviours were treated with a cognitive-behavioural programme. The programme aimed to facilitate the patients' and their carers' ability to adaptively cope with the distress generated by the patients' florid symptoms. Both patients actively co-operated and responded with a marked reduction in symptoms and behavioural disturbance.

Loss and grief in patients with schizophrenia: on living in another world

AIM

Schizophrenia enormously impacts the lives of the patients who have this psychiatric disorder. This study addresses the lived experience of grief in schizophrenia.

METHOD

A qualitative study based on the grounded theory was designed. Ten patients were interviewed in depth on their feelings of loss and ways of coping.

RESULTS

All respondents experienced significant feelings of loss. Internal and external losses were distinguished. Respondents dealt with their losses by accepting their diagnosis and treatment, identifying with other patients, learning about schizophrenia, and searching for meaning.

DISCUSSION

Respondents were able to identify their significant losses and verbalize the accompanied feelings. They went through an intensive grieving process that to a certain extent led to coming to terms. During the interviews, the presence of grief was evident, whereas clinical depression was excluded.

CLINICAL IMPLICATIONS

Interventions may be improved by the following factors: (a) optimal assessment and treatment of symptoms; (b) adequate information about symptoms, treatment and its effects, and prognosis; (c) opportunities to identify with other patients; (d) strengthening of social support; and (e) a relationship of trust with care providers based on an accepting attitude.