1
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Ma M, Shi Z, Chen Y, Ma X. Recovery journey of people with a lived experience of schizophrenia: a qualitative study of experiences. BMC Psychiatry 2023; 23:468. [PMID: 37369995 DOI: 10.1186/s12888-023-04862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Mental health recovery involves an integration of clinical and psychosocial frameworks. The recovery journey of individuals diagnosed with schizophrenia and the factors that influence it have been extensively studied. Because the recovery journey is culturally influenced, we examined the recovery process expriences of individuals diagnosed with schizophrenia in China, focusing on the influence of a Confucian-dominated collectivist and family-centred culture. METHODS An Interpretive Phenomenological Analysis (IPA) study was conducted; data were gathered through in-depth interviews with 11 individuals with lived experience of schizophrenia. RESULTS Four themes were identified in this study: traumatic illness experiences, influence of the family, motives for recovery, and posttraumatic growth, comprising ten subthemes. "For the family" and "relying on oneself" are the main drivers of recovery for individuals with a Chinese cultural background. Some people believe that taking care of themselves is an important way to ease the burden on their families and treat them well. There is a link between 'for the family' and 'relying on oneself. CONCLUSIONS Individuals living with schizophrenia in China have undergone significant traumatic experiences and have profound interactions with their families. Post-traumatic growth reflects an increase in the individual's connection to others and individual agency. It also suggests that the individual is not receiving enough support outside of the family. The impact of individual agency and family relationships should be considered in services that promote recovery, and clinic staff should enhance support outside the home to the individuals.
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Affiliation(s)
- Min Ma
- Wuhan Mental Health center, Wuhan Hospital for Psychotherapy, Rehabilitation Department, Wuhan, China
| | - Zhidao Shi
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Yanhong Chen
- China University of Geosciences Wuhan, Wuhan, China
| | - Xiquan Ma
- Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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2
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Farr J, Rhodes JE, Baruch E, Smith JA. First episode psychotic mania and its aftermath: the experience of people diagnosed with bipolar disorder. PSYCHOSIS 2023. [DOI: 10.1080/17522439.2022.2163686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Joanna Farr
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - John E. Rhodes
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Ella Baruch
- Tower Hamlets Early Intervention Service, London, UK
| | - Jonathan A. Smith
- Department of Psychological Sciences, Birkbeck University of London, London, UK
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3
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Harris O, Lawes A, Andrews C, Jacobsen P. Kintsugi-Identity change and reconstruction following an episode of psychosis: A systematic review and thematic synthesis. Early Interv Psychiatry 2022; 16:689-714. [PMID: 34541814 DOI: 10.1111/eip.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 08/02/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
AIM Research has shown that experiences of psychosis can have a significant impact on an individual's identity. Moreover, the way those who experience psychosis make sense of these changes appears to affect their recovery journey and hold clinical significance. However, this area of research is still very much developing, and there is a need for reviews, which look to synthesise and understand this process of identity change to guide clinicians working in this area as well as future research. This study looks to meet that gap and aims to synthesise qualitative literature exploring the lived experience of identity change amongst people who experience psychosis. METHODS A systematic review using thematic synthesis was carried out. The PRISMA and ENTREQ guidelines were followed in reporting the study. RESULTS Ninety-one papers were identified which met criteria for inclusion and 31 papers included in the synthesis at which point conceptual saturation was judged to have been reached. Five themes were created: psychosis as an obliteration of the old self; the futile fight against psychosis; mourning for who I was; the battle for self as a battle against disempowerment; and recovery as rebirth. CONCLUSIONS Results highlighted the substantive impact an experience of psychosis has on an individual's identity, the key role sense making around these identity changes plays in recovery and the crucial impact of clinicians on the sense-making process. The implications for theory, future research and clinical practice are discussed.
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Affiliation(s)
- Olivia Harris
- Department of Psychology, University of Bath, Bath, UK
| | - Anna Lawes
- Department of Psychology, University of Bath, Bath, UK
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4
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Cohen-Chazani Y, Lavidor M, Gilboa-Schechtman E, Roe D, Hasson-Ohayon I. Meta-Analysis of the Effect of Psychotherapy in an Inpatient Setting: Examining the Moderating Role of Diagnosis and Therapeutic Approach. Psychiatry 2022; 85:399-417. [PMID: 35442174 DOI: 10.1080/00332747.2022.2062660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The current meta-analysis investigates the efficacy of psychotherapy during psychiatric hospitalization and examines the moderating role of diagnosis and therapeutic approach. METHODS We conducted systematic searches in literature databases, including PubMed, PsycInfo, and Google Scholar. In total, 37 samples were included for the meta-analysis with a total of 4,443 patients. The primary outcome was the standardized mean differences in clinical status measured by symptomatic and functional measures. RESULTS The meta-analysis of 22 samples without a control group resulted in the upper end of the medium effect size for the overall effect of treatment during psychiatric hospitalization that included psychotherapy (k = 22, Cohen's d = 0.70, and 95% Cl 0.36 to 1.04). The meta-analysis of 15 samples with a control group resulted in the upper end of the low effect size for the contribution of psychotherapy to the improvement of patients' clinical status measured by symptomatic and functional measures (k = 15, Cohen's d = 0.43, and 95% CI 0.06 to 0.81). No significant effects were uncovered for psychotherapy orientation. Diagnosis was found to moderate the contribution of psychotherapy in an inpatient setting to the improvement of patients' clinical condition. CONCLUSION Psychotherapy during psychiatric hospitalization may be an effective treatment. Across the various samples, psychotherapy has a moderate effect on the reduction of psychiatric symptoms beyond the overall effect of ward treatment.
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5
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Hurtado MM, Villena-Jimena A, Quemada C, Morales-Asencio JM. 'I do not know where it comes from, I am suspicious of some childhood trauma' association of trauma with psychosis according to the experience of those affected. Eur J Psychotraumatol 2021; 12:1940759. [PMID: 34367524 PMCID: PMC8312611 DOI: 10.1080/20008198.2021.1940759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Trauma-related symptoms are often experienced after a first psychotic episode. OBJECTIVE In this study, we conduct a qualitative analysis of referred traumatic experiences of outpatients diagnosed with psychotic disorders. METHOD Focus groups were formed and in-depth interviews conducted with 30 participants, focusing on their experience with the disorder and the health care received. Given the frequency with which trauma and psychosis have been associated in the scientific literature, the nature of this relation is addressed as a secondary objective, via a qualitative analysis. RESULTS Analysis revealed two main themes in the patients' discourse. On many occasions, traumatic experiences were related to the development of the disorder. Although most participants referred to traumatic experiences during childhood, episodes during adult life were also reported, which may have triggered the disorder. The second theme was that of the interlocking relationship between the psychotic experience and certain coercive practices undergone during the provision of health care for psychosis, and the traumatic effects thus generated. CONCLUSIONS The participants considered both themes to be highly important. Accordingly, these issues should be carefully assessed and managed in order to provide appropriate person-centred care.
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Affiliation(s)
- María M Hurtado
- Mental Health Unit, Regional University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | | | - Casta Quemada
- Mental Health Unit, Regional University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - José Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga (IBIMA), Spain.,Faculty of Health Sciences, Universidad de Málaga, Málaga, Spain
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6
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O'Keeffe D, Keogh B, Higgins A. Meaning in Life in Long-Term Recovery in First-Episode Psychosis: An Interpretative Phenomenological Analysis. Front Psychiatry 2021; 12:676593. [PMID: 34408676 PMCID: PMC8365246 DOI: 10.3389/fpsyt.2021.676593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Meaning in Life (MIL) is a central aspect of service user defined personal recovery in mental health. It is unclear whether current knowledge regarding MIL is applicable to the lives of those who have experienced psychosis. As it was not possible to locate any study examining service user perspectives on MIL in first-episode psychosis (FEP), conducting in-depth qualitative research in this area offers an opportunity to develop a conceptualisation of MIL that may be transferable to the broad psychosis spectrum. Aim: The aim of the study was to explore how people find, develop, and maintain MIL approximately 21 years after their FEP diagnosis. Materials and Methods: The study aim was addressed using Interpretative Phenomenological Analysis (IPA). Participants were members of an epidemiologically complete FEP incidence cohort in Ireland. Purposive maximum variation sampling enabled the recruitment of a sample balanced across remission status, age at time of FEP onset, and gender. Semi-structured interviews were conducted circa 21 years post FEP with 16 participants. Data analysis was guided by IPA procedures. Results: Participants experienced MIL as awareness of connectedness to context - the interrelated conditions they existed in (their relationships with the self, others, systems, the environment, and time). Awareness of connectedness to context occurred in five main ways: Being myself - de-othering and authenticity (Enacting identity); Becoming significant where the self is witnessed (Belonging in life); Generating meaning within and beyond systems (Independence); Shaping and being shaped by life (Agency and patiency); and Integrating different perspectives of time (Reconciling temporality). Conclusions: Findings offer the first in-depth understanding of how people diagnosed with a FEP experience MIL in mid-later life recovery. Current tripartite MIL theories do not fully represent the array of MIL perspectives articulated by our participants. MIL concepts developed are potential areas for intervention for mental health services seeking to implement the recovery approach. Findings can be used to foster optimism among service users and their supporters for MIL attainment in psychosis and offer guidance for education, clinical practice, policy, and future research.
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Affiliation(s)
- Donal O'Keeffe
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.,School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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7
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Sips R, Van Duppen Z, Kasanova Z, De Thurah L, Teixeira A, Feyaerts J, Myin-Germeys I. Psychosis as a dialectic of aha- and anti-aha-experiences: a qualitative study. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2020. [DOI: 10.1080/17522439.2020.1798492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Rob Sips
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Zeno Van Duppen
- Department of Psychiatry, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Zuzana Kasanova
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Lena De Thurah
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Ana Teixeira
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jasper Feyaerts
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Vakgroep Psychoanalyse En Raadplegingspsychologie, Universiteit Gent, Gent, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
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8
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Riera-López de Aguileta I, Vila-Badia R, Usall J, Butjosa A, Ochoa S. Coping strategies in first-episode psychosis: A systematic review. Early Interv Psychiatry 2020; 14:252-262. [PMID: 31318154 DOI: 10.1111/eip.12847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 06/09/2019] [Indexed: 12/12/2022]
Abstract
AIMS This paper reviews and discusses the published information on coping strategies in people with a first-episode psychosis (FEP). The objective is to update knowledge about coping strategies used by people with a FEP, to compare these strategies with those used by other mental disorders, and to examine the relationship between coping strategies and other variables in FEP. METHOD A search was conducted using PsycINFO, MEDLINE and PSICODOC between 1995 and 2018 using the following terms: coping strategies or Adaptation, Psychological and FEP. RESULTS A total of 167 studies were found, of which 14 were selected for review. The results suggest the need for a multiple and integrated approach, since there are several factors that are involved in the coping strategies (eg, socio-demographic, clinical and psychological variables) used in the different profiles of psychotic spectrum, specifically in FEP. CONCLUSIONS The role of coping skills is an important issue in psychopathological research in addition to clinical outcome, especially from the point of view of the patients, their social context and their recovery. Moreover, personalized therapies addressed to personal recovery should be considered to develop better coping specifically addressed to patients' needs.
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Affiliation(s)
| | | | - Judith Usall
- PARC SANITARI SANT JOAN DE DÉU. CIBERSAM, Barcelona, Spain
| | - Anna Butjosa
- PARC SANITARI SANT JOAN DE DÉU. CIBERSAM, Barcelona, Spain
| | - Susana Ochoa
- PARC SANITARI SANT JOAN DE DÉU. CIBERSAM, Barcelona, Spain
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9
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Shalev A, Merranko J, Gill MK, Goldstein T, Liao F, Goldstein BI, Hower H, Ryan N, Strober M, Iyengar S, Keller M, Yen S, Weinstock LM, Axelson D, Birmaher B. Longitudinal course and risk factors associated with psychosis in bipolar youths. Bipolar Disord 2020; 22:139-154. [PMID: 31749297 PMCID: PMC7085953 DOI: 10.1111/bdi.12877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To compare the longitudinal clinical course of youths with bipolar disorder (BD) spectrum with lifetime (past, intake, and/or follow-up) psychosis (BDP+) to youths with BD without lifetime psychosis (BDP-). Also, to identify risk factors associated with increased risk of first onset of psychosis during prospective follow-up. METHOD Bipolar disorder youths (BDP+ = 137, BDP- = 233), aged 7-17 years old, were followed on average every 7 months for 11.7 years and were evaluated using standardized instruments. Data were analyzed using linear and generalized linear models for the full sample, as well as for youths who developed first period of psychosis (n = 55). RESULTS After adjusting for confounders, BDP+ youths with one, and in particular ≥2 lifetime psychotic episodes, had higher rates and more severe mood and anxiety symptoms, higher rates of suicidality, psychiatric hospitalizations, and sexual/physical abuse, and poorer psychosocial functioning than BDP- youths. Even before the first onset of psychosis during follow-up, BDP+ youths showed more psychopathology and had more family history of psychiatric illness than those who never developed psychosis. First-onset psychosis was associated with low socioeconomic status (SES), living with one parent, bipolar disorder type one and type two, comorbid anxiety, history of hospitalizations, and family history of mania and suicidality. CONCLUSION BDP+ is associated with poor prognosis and worse clinical picture, even before the onset of psychosis, indicating the need for prompt identification and treatment of these youths. Studies aimed to treat acute symptoms of psychosis, as well as prevent the onset of psychosis, including risk factors amenable to change, are warranted.
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Affiliation(s)
- Amit Shalev
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,,The Herman Dana Division of Pediatric Psychiatry, Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem Israel
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tina Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Heather Hower
- Ontario, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Martin Keller
- Ontario, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Shirley Yen
- Ontario, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Lauren M. Weinstock
- Ontario, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - David Axelson
- Department of Psychiatry, Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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10
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Noiriel A, Verneuil L, Osmond I, Manolios E, Revah-Levy A, Sibeoni J. The Lived Experience of First-Episode Psychosis: A Systematic Review and Metasynthesis of Qualitative Studies. Psychopathology 2020; 53:223-238. [PMID: 33120385 DOI: 10.1159/000510865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/11/2020] [Indexed: 11/19/2022]
Abstract
Both research and care have focused on first episodes of psychosis (FEPs) as a way to address the issue of early stages of schizophrenia and to reduce the duration of untreated psychosis. The objective of this study was to explore specifically the lived experience of FEP from the point of view of patients and their families by applying a metasynthetic approach, including a systematic review of the literature and analyses of qualitative studies on the subject. This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting FEP from the patient or family's perspective. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them. Thirty-eight articles were included, covering data from 554 participants (378 patients and 176 relatives). Three themes emerged from the analyses: (1) When and how does a FEP start? (2) What are its negative and positive aspects? (3) How do patients and families recount FEPs? Our results found important discrepancies between the experiences of patients and those of their families, especially regarding positive aspects. In light of the confusion reported by patients and notable in our results, we also discuss the gap between the name, FEP, and the lived experience of patients and family members in order to explore its practical implications.
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Affiliation(s)
| | | | - Ingrid Osmond
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, France
| | - Emilie Manolios
- ECSTRA Team, UMR-1153, Inserm, Université de Paris, Paris, France.,Service de Psychologie et Psychiatrie de Liaison et d'Urgences, Hôpital Européen Georges Pompidou AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | - Anne Revah-Levy
- ECSTRA Team, UMR-1153, Inserm, Université de Paris, Paris, France.,Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, France
| | - Jordan Sibeoni
- ECSTRA Team, UMR-1153, Inserm, Université de Paris, Paris, France, .,Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, France,
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11
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Shinn AK, Cawkwell PB, Bolton K, Healy BC, Karmacharya R, Yip AG, Öngür D, Pinder-Amaker S. Return to College After a First Episode of Psychosis. SCHIZOPHRENIA BULLETIN OPEN 2020; 1:sgaa041. [PMID: 32984820 PMCID: PMC7503481 DOI: 10.1093/schizbullopen/sgaa041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A first episode of psychosis (FEP) can derail a patient’s educational goals, including attainment of a college education, and this can have lasting ramifications for socioeconomic and health outcomes. Despite this, few studies have examined return to college, which is an important index of real-world educational success after a FEP. In this study, we conducted a longitudinal medical record review of patients in a transdiagnostic outpatient FEP program and performed survival analysis, setting return to college as the endpoint, among the subset of patients whose college education was interrupted. We found that 82% (93/114) of college-enrolled FEP individuals experienced disruptions to their education after FEP, but that return to college also occurred in a substantial proportion (49/88, 56%) among those on leave who had follow-up data. In this sample, the median time to college return was 18 months. When separated by baseline diagnostic category, FEP patients with affective psychotic disorders (FEAP, n = 45) showed faster time to college return than those with primary psychotic disorders (FEPP, n = 43) (median 12 vs 24 mo; P = .024, unadjusted). When adjusted for having no more than 1 psychiatric hospitalization at intake and absence of cannabis use in the 6 months prior to intake (which were also significant predictors), differences by diagnostic category were more significant (hazard ratio 2.66, 95% CI 1.43–4.94, P = .002). Participation in education is an important outcome for stakeholders, and students with FEP can be successful in accomplishing this goal.
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Affiliation(s)
- Ann K Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Kirsten Bolton
- Psychotic Disorders Division, McLean Hospital, Belmont, MA
| | - Brian C Healy
- Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
| | - Rakesh Karmacharya
- Psychotic Disorders Division, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Agustin G Yip
- Psychotic Disorders Division, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Stephanie Pinder-Amaker
- Department of Psychiatry, Harvard Medical School, Boston, MA
- College Mental Health Program, McLean Hospital, Belmont, MA
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12
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Le Trouble Stress Post-Traumatique secondaire à l’expérience de la psychose : une revue de littérature. Encephale 2019; 45:506-512. [DOI: 10.1016/j.encep.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
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13
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Tong J, Simpson K, Alvarez-Jimenez M, Bendall S. Talking about trauma in therapy: Perspectives from young people with post-traumatic stress symptoms and first episode psychosis. Early Interv Psychiatry 2019; 13:1236-1244. [PMID: 30537145 DOI: 10.1111/eip.12761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/19/2018] [Accepted: 11/04/2018] [Indexed: 11/29/2022]
Abstract
AIM Despite recommendations from national guidelines, individuals with first episode psychosis (FEP) are currently unlikely to have the effects of their traumatic experiences assessed and treated within psychosis treatment. This may be due to the mismatch between the objectives of trauma-specific treatments (directly targeting post-traumatic stress symptoms by talking about the trauma) and trauma-informed care (limiting practices that may retraumatise clients). We aimed to gain an understanding of what it was like for young people to talk about trauma in FEP treatment, and how their experiences related to the broad conceptualisations of trauma-informed and trauma-specific treatment approaches. METHODS Semi-structured interviews were conducted with eleven participants (18-27 years) with FEP and post-traumatic stress disorder (PTSD) symptoms after the completion of an intervention for the effects of trauma. Transcripts were analysed using an interpretative phenomenological approach. RESULTS Two superordinate themes were identified, each with subordinate themes. 1. Reluctance to approach the trauma memory: 1a. Not wanting to talk about trauma; 1b. Difficulty acknowledging that the trauma had occurred; 1c. Not wanting to re-experience emotions associated with trauma. 2. Factors aiding the process: 2a. Desire for change; 2b. Not being pushed to talk; 2c. Valuing the case manager; 2d. Time. CONCLUSIONS A majority of participants in the study experienced reluctance when recounting their trauma memories. Being in control of how trauma memories are shared and having time for the therapeutic relationship to develop enhanced participants' readiness for talking about trauma. Incorporating trauma-informed principles and motivational interviewing could aid in facilitating the processes around talking about trauma.
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Affiliation(s)
- Janet Tong
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Katrina Simpson
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
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14
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Bögle S, Boden Z. ‘It was like a lightning bolt hitting my world’: Feeling shattered in a first crisis in psychosis. QUALITATIVE RESEARCH IN PSYCHOLOGY 2019. [DOI: 10.1080/14780887.2019.1631418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sarah Bögle
- London South Bank University, Division of Psychology, School of Applied Science, London, UK
| | - Zoë Boden
- University of Brighton, School of Applied Social Science, Brighton, UK
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15
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Rodrigues R, Anderson KK. The traumatic experience of first-episode psychosis: A systematic review and meta-analysis. Schizophr Res 2017; 189:27-36. [PMID: 28214175 DOI: 10.1016/j.schres.2017.01.045] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/23/2017] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A psychotic episode may be sufficiently traumatic to induce symptoms of post-traumatic stress disorder (PTSD), which could impact outcomes in first-episode psychosis (FEP). The objectives of this systematic review and meta-analysis were to estimate the prevalence of PTSD symptoms in relation to psychosis in FEP and to identify risk factors for the development of PTSD symptoms. METHODS We searched electronic databases and conducted manual searching of reference lists and tables of contents to identify relevant studies. Quantitative studies were included if the population was experiencing FEP and if PTSD was measured in relation to psychosis. Prevalence of PTSD symptoms and diagnoses were meta-analyzed using a random effects model. Potential risk factors for PTSD symptoms were summarized qualitatively. RESULTS Thirteen studies were included. Eight studies assessed PTSD symptoms, three studies assessed full PTSD, and two studies assessed both. The pooled prevalence of PTSD symptoms was 42% (95% CI 30%-55%), and the pooled prevalence of a PTSD diagnosis was 30% (95% CI 21%-40%). Exploratory subgroup analyses suggest that prevalence may be higher in affective psychosis and inpatient samples. Evidence from included studies implicate depression and anxiety as potential risk factors for PTSD symptoms. CONCLUSIONS Approximately one in two people experience PTSD symptoms and one in three experience full PTSD following a first psychotic episode. Evidence-based interventions to treat PTSD symptoms in the context of FEP are needed to address this burden and improve outcomes after the first psychotic episode. Further studies are needed to clarify the associated risk factors.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
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16
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Brew B, Shannon C, Storey L, Boyd A, Mulholland C. A qualitative phenomenological analysis of the subjective experience and understanding of the at risk mental state. Int J Qual Stud Health Well-being 2017; 12:1342504. [PMID: 28689474 PMCID: PMC5510197 DOI: 10.1080/17482631.2017.1342504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Over recent years there has been a growing interest in identifying the early stages of psychosis. The At Risk Mental State (ARMS) is characteristic of the prodromal stages of psychosis and its identification gives rise to a number of clinical and research opportunities including early intervention and prevention of psychosis. This study employs interpretative phenomenological analysis to gain insights into the subjective experience and individuals understanding of the development of their ARMS. Five participants took part and provided information on the experience of symptoms, life prior to onset of their ARMS and their understanding of symptoms and their development through a semi structured interview. From the analysis of transcripts eight themes emerged which were common across participants accounts. Three themes of experience (disturbed world/disturbed self, disconnection with the world, thunderstruck) and five themes of understanding (absence of understanding, use of others, identity, forming links, fragmented understanding) were identified. Themes are explored in detail and discussed in relation to existing literature and theory. Clinical implications, directions for future research, and limitations are discussed within.
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Affiliation(s)
- Benjamin Brew
- a School of Psychology , Queens University Belfast , Belfast , Northern Ireland
| | - Ciaran Shannon
- a School of Psychology , Queens University Belfast , Belfast , Northern Ireland.,b STEP Team , Northern Health and Social Care Trust , Antrim , Northern Ireland
| | - Lesley Storey
- a School of Psychology , Queens University Belfast , Belfast , Northern Ireland
| | - Adrian Boyd
- b STEP Team , Northern Health and Social Care Trust , Antrim , Northern Ireland
| | - Ciaran Mulholland
- b STEP Team , Northern Health and Social Care Trust , Antrim , Northern Ireland.,c School of Medicine, Dentistry and Biomedical Sciences , Queens University Belfast , Northern Ireland
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17
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Onwumere J, Lotey G, Schulz J, James G, Afsharzadegan R, Harvey R, Chu Man L, Kuipers E, Raune D. Burnout in early course psychosis caregivers: the role of illness beliefs and coping styles. Early Interv Psychiatry 2017; 11:237-243. [PMID: 25721376 DOI: 10.1111/eip.12227] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/19/2014] [Indexed: 11/27/2022]
Abstract
AIMS In occupational settings, burnout is a common response to chronic exposure stressors and has been frequently documented in formal caregivers (i.e. paid psychiatric staff). However, the literature is limited on reports of burnout among informal caregivers and particularly within early psychosis groups. The current study sought to investigate reports of burnout in carers of young adults treated within a specialist early psychosis service and links with key appraisals reported about the illness and coping. METHODS Seventy-two carers completed the Maslach Burnout Inventory along with self-report measures of coping styles and illness beliefs. RESULTS Seventy-eight per cent of carers reported high burnout in at least one of the three key burnout markers (i.e. emotional exhaustion, depersonalization or low personal accomplishment). Seven per cent of carers met full criteria for high burnout across all the three domains. A carer's belief about the negative consequences of the illness for themselves was a significant predictor of emotional exhaustion and depersonalization. Low personal accomplishment was linked to a carer's less optimistic beliefs about the illness timeline and fewer reports of adaptive coping. CONCLUSIONS The results provide preliminary support for the importance of asking carers in the early illness phase about their experiences of caregiving. Targeted assessment may serve as a helpful tool to identify and intervene with carers in need of additional support with stress management, use of adaptive coping strategies, and balanced recovery focused information about psychosis.
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Affiliation(s)
- Juliana Onwumere
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gursharan Lotey
- Department of Psychology, Faculty of Arts and Human Sciences, University of Surrey, Surrey, UK
| | - Joerg Schulz
- Department of Psychology, University of Hertfordshire, Hertfordshire, UK
| | - Gareth James
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Roya Afsharzadegan
- Department of Clinical Psychology, School of Psychology, University of East London, London, UK
| | - Raythe Harvey
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Lai Chu Man
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Elizabeth Kuipers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Raune
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
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Expériences traumatiques et état de stress post traumatique dans la schizophrénie. Encephale 2016; 42 Suppl 3:S7-S12. [DOI: 10.1016/s0013-7006(16)30216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Social functioning in patients with a psychotic disorder and first rank symptoms. Psychiatry Res 2016; 237:147-52. [PMID: 26892072 DOI: 10.1016/j.psychres.2016.01.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 11/30/2015] [Accepted: 01/21/2016] [Indexed: 11/20/2022]
Abstract
There have been suggestions that a sense of self emerges through social interaction, which requires an intact capability to distinguish self from others. Here we investigated the contribution of first rank delusions and hallucinations, i.e. symptom expressions of a disturbed sense of self, to social functioning in patients with a psychotic disorder. Life-time and present-state positive symptom clusters (e.g. first rank delusions and hallucinations) and present-state negative symptoms were submitted to hierarchical multiple-regression analyses with (different domains of) social functioning as dependent variable. In addition to negative symptoms (β=-0.48), the life-time presence of first rank delusions is significantly negative associated with level of social functioning, in particular with the quality of interpersonal interactions, with a modest standardized regression coefficient (β=-0.14). We reconfirmed the well-established relationship between negative symptoms and social functioning, but the life-time presence of first rank delusions may also have an subtle ongoing effect on the quality of the interaction with others. We propose that the experience of first rank delusions may be an expression of enduring self-disturbances, leaving patients unsure on how to behave in social interactions.
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Dunkley JE, Bates GW. Recovery and adaptation after first-episode psychosis: The relevance of posttraumatic growth. PSYCHOSIS 2014. [DOI: 10.1080/17522439.2014.936027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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