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Green B, García-Mieres H. Construing journeys to recovery from psychosis: A qualitative analysis of first-person accounts. Psychol Psychother 2022; 95:888-904. [PMID: 35670416 DOI: 10.1111/papt.12408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To perform a qualitative analysis of the factors that were construed as salient in facilitating the process of recovery in the narratives of people with psychosis who had their first-person accounts (FPAs) published in an academic journal. METHODS Computerized textual analysis was undertaken of 156 FPAs written by persons who had experienced psychosis and published in the Schizophrenia Bulletin between 1979 and 2020. Constructs were extracted from the FPAs and coded in terms of Mental health treatment and therapy, Self-management and Multiple factors; recovery processes (Connectedness, Hope, Identity, Meaning and Empowerment), Struggles and Turning points. RESULTS Psychosis impacted on individuals in profound and diverse ways. This was reflected in the different pathways to recovery included in the FPAs. Underlying the different pathways was the salience of re-engagement in the shared reality of others; development of a cohesive and positive self; empowerment through the use of self-management strategies, and making sense of experience through reconstruing what was meaningful. Personal constructs identified in the FPAs provided insight into both challenges faced and alternative avenues of movement that were perceived as available. CONCLUSIONS Processes that support individuals re-engaging with the shared reality of others are central to recovery. Supportive relationships and fostering open dialogue were consistent themes across the different pathways that recovery journeys took. Establishing a meaningful lifestyle and recovering a positive sense of identity were a key challenge following psychosis onset. Appreciation of experiences contained in FPAs has the potential to enhance the effectiveness and humanity of mental health care.
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Affiliation(s)
- Bob Green
- Independent Scholar, Formerly Statewide Forensic Mental Health Team, Queensland Forensic Mental Health Service, Brisbane, Qld, Australia
| | - Helena García-Mieres
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions M'ediques, Barcelona, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain.,Centro Investigación Biomédica en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Fusar‐Poli P, Estradé A, Stanghellini G, Venables J, Onwumere J, Messas G, Gilardi L, Nelson B, Patel V, Bonoldi I, Aragona M, Cabrera A, Rico J, Hoque A, Otaiku J, Hunter N, Tamelini MG, Maschião LF, Puchivailo MC, Piedade VL, Kéri P, Kpodo L, Sunkel C, Bao J, Shiers D, Kuipers E, Arango C, Maj M. The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics. World Psychiatry 2022; 21:168-188. [PMID: 35524616 PMCID: PMC9077608 DOI: 10.1002/wps.20959] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Psychosis is the most ineffable experience of mental disorder. We provide here the first co-written bottom-up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically-informed perspectives. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud-based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self-referentiality and permeated self-world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re-establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,OASIS serviceSouth London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly,National Institute for Health Research, Maudsley Biomedical Research CentreSouth London and MaudsleyLondonUK
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Giovanni Stanghellini
- Department of Psychological, Territorial and Health Sciences“G. d'Annunzio” UniversityChietiItaly,Center for Studies on Phenomenology and Psychiatry, Medical Faculty“D. Portales” UniversitySantiagoChile
| | - Jemma Venables
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Juliana Onwumere
- National Institute for Health Research, Maudsley Biomedical Research CentreSouth London and MaudsleyLondonUK,Department of Psychology, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Bethlem Royal HospitalSouth London and Maudsley NHS Foundation TrustBeckenhamUK
| | - Guilherme Messas
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil
| | | | - Barnaby Nelson
- OrygenParkvilleVICAustralia,Centre for Youth Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Vikram Patel
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMAUSA,Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | | | - Ana Cabrera
- Asociación Española de Apoyo en PsicosisMadridSpain
| | - Joseba Rico
- Asociación Española de Apoyo en PsicosisMadridSpain
| | - Arif Hoque
- Young Person's Mental Health Advisory Group (YPMHAG)King's College LondonLondonUK
| | - Jummy Otaiku
- Young Person's Mental Health Advisory Group (YPMHAG)King's College LondonLondonUK
| | - Nicholas Hunter
- NHS South London and Maudsley (SLaM) Recovery CollegeLondonUK
| | | | - Luca F. Maschião
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil
| | - Mariana Cardoso Puchivailo
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil,Department of PsychologyFAE University CenterCuritibaBrazil
| | - Valter L. Piedade
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil
| | - Péter Kéri
- Global Alliance of Mental Illness Advocacy Networks‐Europe (GAMIAN‐Europe)BrusselsBelgium
| | - Lily Kpodo
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Jianan Bao
- OASIS serviceSouth London and Maudsley NHS Foundation TrustLondonUK,Department of Forensic and Neurodevelopment Sciences, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - David Shiers
- Psychosis Research UnitGreater Manchester Mental Health TrustManchesterUK,Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK,School of MedicineKeele UniversityStaffordshireUK
| | - Elizabeth Kuipers
- National Institute for Health Research, Maudsley Biomedical Research CentreSouth London and MaudsleyLondonUK,Department of Psychology, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Bethlem Royal HospitalSouth London and Maudsley NHS Foundation TrustBeckenhamUK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental HealthHospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of MadridMadridSpain
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
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Abstract
Aims and MethodIn order to investigate cognitive aspects of the experience of delusions, including onset and recovery, autobiographical accounts of schizophrenia were reviewed.ResultsThe 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 ImplicationsFurther exploration of spontaneous coping strategies in recovery from delusions through personal accounts of illness would be valuable.
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Rinaldi M, Killackey E, Smith J, Shepherd G, Singh SP, Craig T. First episode psychosis and employment: a review. Int Rev Psychiatry 2010; 22:148-62. [PMID: 20504055 DOI: 10.3109/09540261003661825] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite considerable growth in treatments, interventions, services and research of young people with a first episode of psychosis, little attention has been given to the priorities of these young people, in particular, gaining employment. A literature review was undertaken with the aim of investigating: 1) whether young people with a first episode of psychosis want to work, 2) what challenges they experience regarding work, 3) what is understood about employment outcomes, 4) what the most effective interventions to enable them to gain employment may be, and 5) what the associated costs may be. The review found that these young people appear to want to work yet face a range of psychological and social challenges to achieving this. Typically by the time they first come into contact with mental health services a proportion are already falling out of education and employment, and this decline continues with contact with services. However, there are specific interventions that can support them to gain employment. The Individual Placement and Support approach, adapted to include support to fulfil educational goals, has demonstrated that a mean of 69% of young people with a first episode of psychosis can gain education and employment compared to 35% of controls.
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Affiliation(s)
- Miles Rinaldi
- South West London and St George's Mental Health NHS Trust, London, UK.
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