1
|
Powell T, Glozier N, Conn K, Einboden R, Buus N, Caldwell P, Milton A. The impact of early intervention psychosis services on hospitalisation experiences: a qualitative study with young people and their carers. BMC Psychiatry 2024; 24:350. [PMID: 38730333 PMCID: PMC11088060 DOI: 10.1186/s12888-024-05758-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND While a core aim of early intervention psychosis services (EIPS) is to prevent hospitalisation, many with a first episode of psychosis (FEP) will require inpatient care. We explored young people's (YP) and their carers' hospitalisation experiences prior to and during EIPS engagement and how factors across these services influenced these experiences. METHODS Using purposive sampling, we recruited twenty-seven YP, all of whom had been involved with the hospital system at some stage, and twelve support persons (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration with secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician, and academic researchers) used an inductive thematic analysis process. RESULTS Four key themes were identified as influential in shaping participant's hospital experiences and provide ideas for an approach to care that is improved by the effective coordination of that care, and includes this care being delivered in a trauma informed manner: (1) A two-way street: EIPS affected how participants experienced hospitalisation, and vice versa; (2) It's about people: the quality and continuity of relationships participants had with staff, in hospital and at their EIPS, was central to their experience; (3) A gradual feeling of agency: participants viewed EIPS as both reducing involuntary care and supporting their self-management; and (4) Care coordination as navigation for the healthcare system: great when it works; frustrating when it breaks down. CONCLUSIONS Hospitalisation was viewed as a stressful and frequently traumatic event, but a approach to care founded on trust, transparency, and collaboration that is trauma-informed ameliorated this negative experience. Consistent EIPS care coordination was reported as essential in assisting YP and carers navigate the hospital system; conversely, discontinuity in EIPS staff and lack of integration of EIPS with hospital care undermined the positive impact of the EIPS care coordinator during hospitalisation. Care coordinator involvement as a facilitator, information provider, and collaborator in inpatient treatment decisions may improve the usefulness and meaningfulness of hospital interventions.
Collapse
Affiliation(s)
- Tacita Powell
- Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Nicholas Glozier
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- The University of Sydney and Australian Research Council (ARC) Centre of Excellence for, Camperdown, Australia
| | - Katrina Conn
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- Department of Education, NSW, Sydney, Australia
| | - Rochelle Einboden
- School of Nursing, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario (CHEO) & CHEO Research Institute, Ottawa, Canada
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- School of Nursing, Western Sydney University, Camperdown, Australia
| | - Niels Buus
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Patrick Caldwell
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Alyssa Milton
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
- The University of Sydney and Australian Research Council (ARC) Centre of Excellence for, Camperdown, Australia.
| |
Collapse
|
2
|
Darker CD, Nicolson G, Reddon H, O'Connor K, Jennings R, O'Connell N. Monthly engagement with EIP keyworkers was associated with a five-fold increase in the odds of engagement with psychosocial interventions. BMC Psychiatry 2024; 24:96. [PMID: 38317157 PMCID: PMC10840293 DOI: 10.1186/s12888-024-05577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. METHODS A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. RESULTS There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43-13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63-18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64-8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. CONCLUSIONS This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact.
Collapse
Affiliation(s)
- C D Darker
- Discipline of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - G Nicolson
- Health Promotion and Improvement Department, HSE Health and Wellbeing, 1st Floor Old National Ambulance Training Building, St Marys Hospital Campus, Phoenix Park, Dublin 20, Chapelizod, D20 TY72, Ireland
| | - H Reddon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - K O'Connor
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
| | - R Jennings
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - N O'Connell
- Sexual Health and Crisis Pregnancy Programme, HSE Health and Wellbeing, Strategy and Research, 89-94 Capel St, Dublin 1, Dublin, D01 P281, Ireland
| |
Collapse
|
3
|
Xavier SM, Barbosa S, Correia AF, Dindo V, Sequeira M, Maia T, Goes AR. Images that speak: A Portuguese Photovoice study on the psychosocial experience of a migrant population from Cape Verde after a first episode of psychosis. Transcult Psychiatry 2023:13634615231187252. [PMID: 37519012 DOI: 10.1177/13634615231187252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Several migrant populations have been identified worldwide as high-risk groups for psychosis because of their experience of social adversity. Recent evidence suggests that the local contexts in which these populations live should be addressed in their complexity to take into account individual and larger societal environmental aspects. This study aimed to assess the lived experiences of a group of migrant Cape Verdean patients, who had been recently hospitalized for a first episode of psychosis in a mental health service on the outskirts of Lisbon, Portugal. The study used Photovoice, a qualitative participatory research method in which people's experiences are documented through photography. Six individuals were recruited, and five weekly sessions were conducted to collect data that were analyzed thematically. Emergent themes addressed two main categories of well-being and illness. Participant concepts of well-being were rooted in a definition of freedom encompassing cultural expression, conveyed by familiar environments and supporting communities. Cultural differences may be experienced as important obstacles for well-being and can be associated with feelings of oppression and guilt. Participants' accounts focused on positive aspects of life despite illness and on personal concepts of recovery. The study findings contribute to knowledge of the dynamics of migrants' social experience and underscore the importance of socially and culturally informed mental healthcare institutions.
Collapse
Affiliation(s)
| | | | | | - Vera Dindo
- Hospital Professor Doutor Fernando Fonseca
- Sahlgrenska University Hospital
| | - Márcia Sequeira
- Hospital Professor Doutor Fernando Fonseca
- Hunter New England Health District
| | | | | |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
| |
Collapse
|
5
|
da Silva AHS, Peixoto LE, Martin IDS, Galera SAF, Vedana KGG, de Freitas LA, Zanetti ACG. Psychotic relapses from the perspective of patients and family members. Arch Psychiatr Nurs 2022; 41:300-5. [PMID: 36428064 DOI: 10.1016/j.apnu.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022]
Abstract
This qualitative study was carried out with 10 dyads of patients-family members to explore their perception about psychotic relapses. Data were collected through a semi-structured interview from April to August 2019, in Brazil, and analyzed using the thematic analysis proposed by Braun & Clark. Four main themes emerged from the interviews: (1) defining and describing the psychotic relapses; (2) risk factors for psychotic relapse; (3) protective factors for psychotic relapse; and (4) early warning signs: identification of an episode of psychotic relapse. Exploring the perception of patients with psychotic disorders and their families about relapse is fundamental for the development of relapse risk assessment tools and to guide further research on this topic.
Collapse
|
6
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Olivia Harris
- Department of Psychology, University of Bath, Bath, UK
| | - Anna Lawes
- Department of Psychology, University of Bath, Bath, UK
| | | | | |
Collapse
|
7
|
Iyer SN, Malla A, Taksal A, Maraj A, Mohan G, Ramachandran P, Margolese HC, Schmitz N, Joober R, Rangaswamy T. Context and contact: a comparison of patient and family engagement with early intervention services for psychosis in India and Canada. Psychol Med 2022; 52:1538-1547. [PMID: 32981550 DOI: 10.1017/s0033291720003359] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is unknown whether patient disengagement from early intervention services for psychosis is as prevalent in low- and middle-income countries (LMICs) like India, as it is in high-income countries (HICs). Addressing this gap, we studied two first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized lower service disengagement among patients and higher engagement among families in Chennai, and that family engagement would mediate cross-site differences in patient disengagement. METHODS Sites were compared on their 2-year patient disengagement and family engagement rates conducting time-to-event analyses and independent samples t tests on monthly contact data. Along with site and family involvement, Cox proportional hazards regression included known predictors of patient disengagement (e.g. gender). RESULTS The study included data about 333 patients (165 in Montreal, 168 in Chennai) and their family members (156 in Montreal, 168 in Chennai). More Montreal patients (19%) disengaged before 24 months than Chennai patients (1%), χ2(1, N = 333) = 28.87, p < 0.001. Chennai families had more contact with clinicians throughout treatment (Cohen's d = -1.28). Family contact significantly predicted patient disengagement in Montreal (HR = 0.87, 95% CI 0.81-0.93). Unlike in Chennai, family contact declined over time in Montreal, with clinicians perceiving such contact as not necessary (Cohen's d = 1.73). CONCLUSIONS This is the first investigation of early psychosis service engagement across a HIC and an LMIC. Patient and family engagement was strikingly higher in Chennai. Maintaining family contact may benefit patient engagement, irrespective of context. Findings also suggest that differential service utilization may underpin cross-cultural variations in psychosis outcomes.
Collapse
Affiliation(s)
- Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Anika Maraj
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
| | | | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis- McGill University Health Centre (PEPP-MUHC), Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
| |
Collapse
|
8
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
9
|
Rajagukguk S, Suryani S, Sutini T, Tasijawa FA. The Experience of Caregivers with First-Episode Psychosis Children at General Hospital of Dumai, Riau Province. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Caregivers with first-episode psychosis (FEP) children often encounter problems and challenges. The importance of caregiver role in managing FEP appropriately will influence the life quality of a person with psychosis.
AIM: The study aimed to explore the experience of caregivers who have children with FEP at General Hospital of Dumai.
METHODS: The study was a qualitative study with a phenomenology approach. In-depth interviews were conducted with eight primary caregivers aged 41–58 years with FEP children at General Hospital of Dumai. The interview transcript was analyzed using the Colaizzi method.
RESULTS: Based on the study, five essential themes emerged, for example, caring for FEP is harder than looking after a thousand buffaloes, mixed feelings, believing that the child experiences mystical things, the extended family is a supporter in caring for FEP, and praying and surrender to God.
CONCLUSION: The implications for nursing practice are implementing support group therapy and family psychoeducation programs for reduce the caregiver burden.
Collapse
|
10
|
Cox L, Miller C. A qualitative systematic review of Early Intervention in Psychosis service user perspectives regarding valued aspects of treatment with a focus on cognitive behavioural therapy. tCBT 2021; 14. [DOI: 10.1017/s1754470x2100026x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background:
Despite the increasing evidence base and focus given to Early Intervention in Psychosis (EIP) services, qualitative literature remains sparse, particularly in relation to the ‘At Risk Mental State’ (ARMS) group. Although research has looked to service user experience within EIP, data have not been collated to understand valued aspects of treatment across both EIP groups: first episode psychosis (FEP) and ARMS, particularly regarding cognitive behavioural therapy (CBT).
Aims:
To conduct a systematic review of qualitative literature to examine service user perspectives on support provided in EIP treatment with a focus on CBT.
Method:
This was a thematic synthesis of qualitative studies. Nine studies were included in the analysis identified through a systematic database search and citation tracking. Studies were critically appraised using the critical appraisal skills programme tool.
Results:
Nine studies were identified for inclusion. Six analytical themes and 20 descriptive categories were identified.
Conclusions:
User perspectives confirm previous findings highlighting importance of therapeutic relationships for treatment success. Normalisation, learning and understanding were valued across both groups, which increased coping, and can be facilitated throughout the EIP journey. Harnessing the support of those involved in users’ care and understanding these relationships further enhances interventions utilised. Understanding the stage the individual is at regarding their experiences is essential in relation to targeting support. Transdiagnostic aspects of CBT were valued across both groups. ARMS referred to more specific strategies and there were some differences regarding coping styles and flexibility preferences; however, this may be due to group differences in problem trajectory and care provision.
Collapse
|
11
|
Ben-David S, Kealy D, Hanson J, Ortiz R. Perspectives on personal identity in the early stages of psychosis: A survey of Canadian clinicians. Early Interv Psychiatry 2021; 15:1038-1043. [PMID: 32881357 DOI: 10.1111/eip.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/13/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022]
Abstract
AIM Identity-related concerns represent an important aspect of young people's experience in early psychosis. Knowledge regarding clinicians' perspectives on this issue, however, is limited. Thus, the present study was developed to understand Canadian clinicians' perspectives on personal identity-related concerns in early psychosis. METHODS An online survey was distributed to 331 multiprofessional clinicians working in early psychosis intervention programs in a Canadian province. Clinicians were asked about their opinions regarding the salience of identity in early psychosis using Likert-rated items and open response questions. RESULTS Nearly all of the clinicians agreed that identity is an important issue for clinical attention, yet only half of the clinicians endorsed a high level of confidence in their ability to address issues related to identity in treatment. Although several clinical strategies were identified, specific evidence-based approaches for strengthening identity in early psychosis remain lacking. CONCLUSIONS Findings indicate a need for early psychosis programs to invest in identity- related training for clinicians.
Collapse
Affiliation(s)
- Shelly Ben-David
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Hanson
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| | - Radha Ortiz
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| |
Collapse
|
12
|
Bonfils KA, Novick DM. Application of Interpersonal and Social Rhythm Therapy (IPSRT) for Depression Associated With Schizophrenia Spectrum Disorders. Am J Psychother 2021; 74:127-134. [PMID: 33445959 DOI: 10.1176/appi.psychotherapy.20200024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
People with schizophrenia spectrum disorders frequently experience depression, yet depressive symptoms are often unaddressed. The authors propose that interpersonal and social rhythm therapy (IPSRT) may be effective for individuals with these disorders who experience depression. IPSRT is a manualized, evidence-based treatment for bipolar disorders. It combines the core elements of interpersonal psychotherapy for unipolar depression with social rhythm therapy to target disrupted social rhythms. The authors highlight evidence for the potential utility of IPSRT to treat patients with schizophrenia spectrum disorders and present a case example. IPSRT is one promising therapy that could fill a treatment gap for people with schizophrenia spectrum disorders by addressing depressive symptoms. Future work should build on this rationale and case example to design and implement a randomized controlled trial of IPSRT for treatment of schizophrenia spectrum disorders and evaluate needed modifications.
Collapse
Affiliation(s)
- Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg (Bonfils); U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Novick)
| | - Danielle M Novick
- School of Psychology, University of Southern Mississippi, Hattiesburg (Bonfils); U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Novick)
| |
Collapse
|
13
|
White R, Haddock G, Campodonico C, Haarmans M, Varese F. The influence of romantic relationships on mental wellbeing for people who experience psychosis: A systematic review. Clin Psychol Rev 2021; 86:102022. [PMID: 33819779 DOI: 10.1016/j.cpr.2021.102022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/29/2021] [Accepted: 03/17/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Whilst it is generally accepted that supportive relationships facilitate recovery from psychosis, much less is known about the role of romantic relationships in people with psychosis. This review aimed to synthesise quantitative literature regarding the impact of romantic relationships on the mental health and general wellbeing of people who experience psychosis. METHOD A systematic review of electronic databases (PsychINFO, PubMed, Web of Science) was carried out using search terms relating to psychosis and romantic relationships. Papers were selected for inclusion by independent reviewers. Quality assessment was completed and a narrative synthesis produced. RESULTS Fifty-eight studies reporting the association between romantic relationships and psychotic symptoms, depression, posttraumatic stress disorder, suicidality, quality of life, satisfaction with life and self-esteem were included. Results were mixed but indicated having a romantic partner may be associated with reduced positive and negative symptoms of psychosis, but increased depressive symptoms. Tentative explanations for these findings, such as functioning prior to onset of psychosis, social support and relationship quality are explored. CONCLUSION Findings highlight the importance of this often-overlooked area in clinical practice. Studies with robust design, which specifically aim to understand the relationship between romantic relationships and wellbeing for people who experience psychosis are needed.
Collapse
Affiliation(s)
- Rebecca White
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Manchester, UK
| | - Carolina Campodonico
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Maria Haarmans
- Cathie Marsh Institute, Centre on Dynamics of Ethnicity (CoDE), Department of Sociology, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Manchester, UK
| |
Collapse
|
14
|
Valentine L, Grace D, Pryor I, Buccilli K, Sellars M, Francey S, Simmons M. "When I'm Thinking Straight, I Can Put Things in Place for When I'm Not." | Exploring the Use of Advance Statements in First-Episode Psychosis Treatment: Young People, Clinician, and Carer Perspectives. Community Ment Health J 2021; 57:18-28. [PMID: 33058044 DOI: 10.1007/s10597-020-00721-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Advance statements represent a promising but relatively unexplored means to empower young people with first-episode psychosis to actively participate in their own mental health care. This qualitative study explored the use of advance statement's for young people with first-episode psychosis, as well as their carers and clinicians, and provided actionable feedback on how to better meet the needs and preferences of these key stakeholders and more effectively implement advance statements in clinical settings.
Collapse
|
15
|
Yang LH, Blasco D, Lieff SA, Le PD, Li Y, Broeker M, Mascayano F, Bello I, Nossel I, Dixon L. Stigma of Treatment Stages for First-Episode Psychosis: A Conceptual Framework for Early Intervention Services. Harv Rev Psychiatry 2021; 29:131-41. [PMID: 33666396 DOI: 10.1097/HRP.0000000000000288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Early intervention services (EIS; in the United States, Coordinated Specialty Care) can lead to substantial improvements in psychiatric symptoms and social functioning for individuals with first-episode psychosis who engage in treatment. Nevertheless, stigma associated with early intervention services can limit their full potential benefits by preventing or reducing participation. Drawing from Corrigan's "why try" model positing relationships between public and self-stigma, engagement in treatment services, and the EIS treatment model, this article proposes a framework that delineates how distinct forms of stigma are linked to given stages of treatment engagement in first-episode psychosis. We identify three phases of engagement: (1) community outreach, which has associations with public stigma; (2) the referral and evaluation process, which primarily has associations with self-stigma; and (3) EIS, which have associations with self-stigma and its psychosocial consequences. For each phase, we describe evidence-based strategies typically provided by EIS programs, using OnTrackNY as an exemplary model, to illustrate potential linkages in our conceptual framework. By specifying how distinct forms of stigma are associated with EIS treatment stages, this framework is intended to guide EIS programs in explicitly addressing stigma to optimize recovery of individuals with first-episode psychosis.
Collapse
|
16
|
Melton R, Blajeski S, Glasser D. Understanding Individual and Family Experiences Associated with DUP: Lessons from the Early Assessment and Support Alliance (EASA) Program in Oregon, USA. Community Ment Health J 2020; 56:1121-1127. [PMID: 32157514 DOI: 10.1007/s10597-020-00599-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
Research shows that a longer duration of untreated psychosis (DUP) is associated with worse psychiatric outcomes, with average length of DUP of 73 weeks in the U.S. The aim was to examine the DUP period for first episode psychosis in Oregon, with a focus on the processes between the first positive symptoms and first treatment. To investigate DUP, researchers used methods consistent with grounded theory to collect data from 9 participants and their families about the process between onset of psychotic symptoms and entrance into treatment. Results suggest that recognition of symptoms was the primary driver of help-seeking in this study, and this was influenced by type of symptom as well as the presence or absence of supportive others, which in most cases was regular family contact. Implications indicate a need for in-depth research on individual and family recognition of symptoms, as well as underscoring the need for community education.
Collapse
Affiliation(s)
- Ryan Melton
- Regional Research Institute (RRI), Portland State University, Suite 918, 1600 SW 4th Ave., Portland, OR, 97201, USA.
| | - Shannon Blajeski
- Regional Research Institute (RRI), Portland State University, Suite 918, 1600 SW 4th Ave., Portland, OR, 97201, USA
| | - Diana Glasser
- Regional Research Institute (RRI), Portland State University, Suite 918, 1600 SW 4th Ave., Portland, OR, 97201, USA
| |
Collapse
|
17
|
Corsico P. Psychosis, vulnerability, and the moral significance of biomedical innovation in psychiatry. Why ethicists should join efforts. Med Health Care Philos 2020; 23:269-279. [PMID: 31773383 PMCID: PMC7260249 DOI: 10.1007/s11019-019-09932-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The study of the neuroscience and genomics of mental illness are increasingly intertwined. This is mostly due to the translation of medical technologies into psychiatry and to technological convergence. This article focuses on psychosis. I argue that the convergence of neuroscience and genomics in the context of psychosis is morally problematic, and that ethics scholarship should go beyond the identification of a number of ethical, legal, and social issues. My argument is composed of two strands. First, I argue that we should respond to technological convergence by developing an integrated, patient-centred approach focused on the assessment of individual vulnerabilities. Responding to technological convergence requires that we (i) integrate insights from several areas of ethics, (ii) translate bioethical principles into the mental health context, and (iii) proactively try to anticipate future ethical concerns. Second, I argue that a nuanced understanding of the concept of vulnerability might help us to accomplish this task. I borrow Florencia Luna's notion of 'layers of vulnerability' to show how potential harms or wrongs to individuals who experience psychosis can be conceptualised as stemming from different sources, or layers, of vulnerability. I argue that a layered notion of vulnerability might serve as a common ground to achieve the ethical integration needed to ensure that biomedical innovation can truly benefit, and not harm, individuals who suffer from psychosis.
Collapse
Affiliation(s)
- Paolo Corsico
- Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
| |
Collapse
|
18
|
Damiani S, Fusar-Poli L, Brondino N, Provenzani U, Baldwin H, Fusar-Poli P, Politi P. World/self ambivalence: A shared mechanism in different subsets of psychotic experiences? Linking symptoms with resting-state fMRI. Psychiatry Res Neuroimaging 2020; 299:111068. [PMID: 32208349 DOI: 10.1016/j.pscychresns.2020.111068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 12/27/2022]
Abstract
The psychosis spectrum comprises heterogeneous disorders characterized by both world-related and self-related symptoms. How these symptoms may arise with similar features in spite of the different aetiologies is yet an unsolved question. In behavior narrative review, we compare three conditions characterized by psychotic experiences (schizophrenia, substance-use disorder and sensory-deprivation) searching for links between their phenomenological features and the mechanisms underlying their onset. Clinically, psychotic experiences are characterized by the reciprocal contamination of world- and self-related contents, termed 'world/self ambivalence'. Neuroimaging evidence suggests that the imbalance between stimuli-, self-, and attention-related functional networks (visual/auditory, default-mode, and salience network respectively) assumes central relevance in all the conditions considered. Phenomenology and neurobiology were thus interrelated in light of the reviewed literature, identifying two key neuronal mechanisms which may lead to world/self ambivalence. First, psychotic experiences are associated with the relative dominance of one network over the other (default-mode over auditory/visual networks, or vice-versa), prompting an excess of internal or external pressure to the experienced ambivalence between world and self. Second, an altered salience network resting-state functional connectivity could generate a dysregulation of the attentive fluctuations from self- to world-related activity, thus blurring the boundary between the environment and oneself, labelled the 'world/self boundary'.
Collapse
Affiliation(s)
- Stefano Damiani
- University of Pavia, Department of Brain and Behavioral Sciences. Via Bassi 21, 27100, Pavia, Italy..
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, Via Santa Sofia 78, 95123, Catania, Italy
| | - Natascia Brondino
- University of Pavia, Department of Brain and Behavioral Sciences. Via Bassi 21, 27100, Pavia, Italy
| | - Umberto Provenzani
- University of Pavia, Department of Brain and Behavioral Sciences. Via Bassi 21, 27100, Pavia, Italy
| | - Helen Baldwin
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research, Maudsley Biomedical Research Center, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Paolo Fusar-Poli
- University of Pavia, Department of Brain and Behavioral Sciences. Via Bassi 21, 27100, Pavia, Italy.; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; OASIS service, SLaM NHS Foundation Trust, London, United Kingdom
| | - Pierluigi Politi
- University of Pavia, Department of Brain and Behavioral Sciences. Via Bassi 21, 27100, Pavia, Italy
| |
Collapse
|
19
|
Abstract
Little is known about the perceptions of sibling relationships from the direct perspective of service users with mental health difficulties; this study aimed to address this gap. Semi-structured interviews were carried out with adult male inpatients who had severe and enduring mental health difficulties. Interpretative phenomenological analysis was used to analyse the data and revealed three main themes: (1) The closeness of the sibling bond; (2) The change in sibling dynamics following diagnosis and admission; (3) Siblings' contribution to mental health and recovery. The implications of involving siblings in care and the benefits of service user led research are discussed.
Collapse
|
20
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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,
| |
Collapse
|
21
|
Haidl TK, Seves M, Eggers S, Rostamzadeh A, Genske A, Jünger S, Woopen C, Jessen F, Ruhrmann S, Vogeley K. Health literacy in clinical-high-risk individuals for psychosis: A systematic mixed-methods review. Early Interv Psychiatry 2019; 13:1293-1309. [PMID: 30688012 DOI: 10.1111/eip.12776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/30/2018] [Accepted: 12/26/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Numerous studies suggest that health literacy (HL) plays a crucial role in maintaining and improving individual health. Empirical findings highlight the relation between levels of a person's HL and her/his clinical outcome. To date, the role of HL in persons at-risk for psychosis has not been systematically reviewed. METHODS We conducted a systematic review using a mixed-methods approach to analyse a variety of study types. Peer-reviewed publications were systematically searched in PUBMED, Cochrane Library, PsycINFO and Web of Science. RESULTS The search string returned 10587 publications. After screening, 15 quantitative, four qualitative studies and two reviews were included. Only one study assessed HL as primary outcome, assessing knowledge and beliefs about psychosis among the general population. In the other studies, sub-dimensions of HL were investigated. None of the publications operationalized HL or it's sub-dimensions with a validated measure. CONCLUSIONS A lack of understanding of their condition, and fear of stigmatization, were associated with a delay in help-seeking among people with clinical-high-risk state for psychosis. Family members, school personnel, general practitioners and the internet play a crucial role in the HL process. Considerable barriers in obtaining adequate specialist support emphasize the urgent need of a "HL environment" for persons at risk for psychosis.
Collapse
Affiliation(s)
- Theresa K Haidl
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Mauro Seves
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Susanne Eggers
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Ayda Rostamzadeh
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Anna Genske
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Saskia Jünger
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
22
|
Affiliation(s)
- S. Ben-David
- School of Social Work, University of British Columbia - Okanagan, Kelowna, Canada
| | - D. Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| |
Collapse
|
23
|
Abstract
Purpose
The onset of psychosis typically develops during adolescence, a crucial period for beginning the transition from family to independence and developing a stable sense of self. Recovery amongst adolescents experiencing early onset psychosis has not yet been investigated with reference to its influence on self-identity. The purpose of this paper is to explore the impact living with early onset psychosis has on self-identity for adolescents in recovery.
Design/methodology/approach
A purposive sample of ten adolescents aged between 16 and 18 years from an Early Intervention Service in the Scottish National Health Service were recruited. All had experienced at least one episode of psychosis and were within three years of first contact with the service. Semi-structured interviews were adopted to capture adolescents’ perspectives concerning their experiences of recovery from psychosis and the impact on self-identity. All interviews were audio-recorded, transcribed and thematically analysed.
Findings
Qualitative analysis of adolescents’ accounts revealed how recovery from psychosis involves working with individual explanatory frameworks concerning uncertain identities and status ambiguity, a decrease in referent points and unfavourable social comparisons (emphasising loss, grief and self-criticism).
Research limitations/implications
Supporting adolescents experiencing early psychosis involves education, rebuilding relationships with self and others and providing access to psychotherapeutic interventions to aid self-identity development when needed.
Originality/value
The originality of this paper lies in the importance of identity, recovery, human reconnection, advocacy and community reintegration for adolescents experiencing psychosis. Public mental health campaigns to tackle the stigma surrounding psychosis are essential to assisting adolescents in developing their sense of self through their recovery journeys.
Collapse
|
24
|
Gee B, Hodgekins J, Lavis A, Notley C, Birchwood M, Everard L, Freemantle N, Jones PB, Singh SP, Amos T, Marshall M, Sharma V, Smith J, Fowler D. Lived experiences of negative symptoms in first-episode psychosis: A qualitative secondary analysis. Early Interv Psychiatry 2019; 13:773-779. [PMID: 29573562 DOI: 10.1111/eip.12558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 12/08/2017] [Accepted: 02/04/2018] [Indexed: 11/27/2022]
Abstract
AIM Exploring how negative symptoms are experienced and understood by individuals with lived experience of psychosis has the potential to offer insights into the complex psychosocial processes underlying negative symptom presentations. The aim of the current study was to investigate lived experiences of negative symptoms through secondary analysis of interviews conducted with individuals recovering from first-episode psychosis. METHOD Transcripts of in-depth interviews with participants (n = 24) recruited from Early Intervention in Psychosis services were analysed thematically with a focus on participants' experiences and personal understandings of features corresponding to the negative symptoms construct. RESULTS Descriptions of reductions in expression, motivation and sociability were common features of participants' accounts. Several participants described the experience of having difficulty interacting as like being a "zombie". Some participants experienced diminished capacity for emotion, thought or drive as underlying these experiences. However, participants typically attributed reductions in expression, motivation and sociability to medication side-effects, lack of confidence or active avoidance intended to protect them from rejection or ridicule, sometimes linked to internalized stigma. CONCLUSIONS Personal accounts of experiences of reduced expression, motivation and sociability during first-episode psychosis highlight the personal meaningfulness and role of agency in these features, challenging the framing of negative symptoms as passive manifestations of diminished capacity.
Collapse
Affiliation(s)
- Brioney Gee
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Anna Lavis
- University of Birmingham, Institute of Applied Health Research, Edgbastongh, Birmingham, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Max Birchwood
- University of Warwick, Warwick Medical School, Coventry, UK
| | - Linda Everard
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Nick Freemantle
- University College London, Department of Primary Care and Population Health, London, UK
| | - Peter B Jones
- University of Cambridge, Department of Psychiatry, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, UK
| | - Swaran P Singh
- University of Warwick, Warwick Medical School, Coventry, UK
| | - Tim Amos
- University of Bristol, Bristol Medical School, Bristol, UK
| | - Max Marshall
- University of Manchester, School of Health Sciences, Manchester, UK
| | - Vimal Sharma
- University of Chester, Faculty of Health and Social Care, Chester, UK.,Cheshire and Wirral Partnership NHS Foundation Trust, UK
| | - Jo Smith
- University of Worcester, Institute of Health and Society, Worcester, UK
| | - David Fowler
- University of Sussex, School of Psychology, Brighton, UK
| |
Collapse
|
25
|
Bergström T, Seikkula J, Holma J, Mäki P, Köngäs-Saviaro P, Alakare B. How do people talk decades later about their crisis that we call psychosis? A qualitative study of the personal meaning-making process. Psychosis 2019. [DOI: 10.1080/17522439.2019.1603320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
- Department of Psychiatry, Länsi-Pohja healthcare district, Kemi, Finland
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Juha Holma
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Pirjo Mäki
- Department of Psychiatry, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | | | - Birgitta Alakare
- Department of Psychiatry, Länsi-Pohja healthcare district, Kemi, Finland
| |
Collapse
|
26
|
Spikol A, Murphy J. 'Something wasn't quite right': a novel phenomenological analysis of internet discussion posts detailing initial awareness of psychosis. Clin Schizophr Relat Psychoses 2019:CSRP.SPJM.032819. [PMID: 30939035 DOI: 10.3371/csrp.spjm.032819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION A significant number of psychosis studies have focussed on and have attempted to model and frame the earliest psychosis experiences. Using a wide array of methodologies and targeting a variety of 'at risk' groups, researchers have offered much to inform our treatment responses, and understanding of psychosis onset and development. OBJECTIVES Due to the nature of scientific investigation however and investigator led exploration, those who experience psychosis are rarely afforded ultimate free rein to dictate and direct the exchange of information or to impose their unique narrative on that which is being explored. In an attempt to address this, the current study opportunistically harvested rich self-report data from replies to the question, "People that have been diagnosed with schizophrenia, what was the first time you noticed something wasn't quite right?" on the internet discussion forum Reddit.com. METHODS User data was analysed using Interpretive Phenomenological Analysis to identify key themes in participants' first experiences and initial awareness of psychosis. RESULTS While respondents varied widely in their recounted experiences and chose to describe these experiences in a variety of ways, analysis showed that (i) respondent distress was associated with psychosis onset timeframe, negative-voice auditory hallucinations, visual hallucinations, paranoid delusions, and insight (ii) early childhood psychosis experience resulted in novel explanatory schemas and psychosis/distress progression with contributory factors in adolescence and (iii) 41.3% of the sample reported self-realisation in gaining insight and greater insight was associated with help-seeking behaviour. CONCLUSIONS This novel use of publicly shared experiential data might enrich our existing qualitative literature concerning early psychosis.
Collapse
Affiliation(s)
- Amanda Spikol
- School of Psychology, Ulster University, Northern Ireland
| | - Jamie Murphy
- School of Psychology, Ulster University, Northern Ireland
| |
Collapse
|
27
|
Abstract
OBJECTIVE This study elicited factors that shaped treatment decision making for young adults and their key supporters after an initial hospitalization for psychosis to generate hypotheses about how to improve service engagement. METHODS This prospective, longitudinal, ethnographic study (using home visits, interviews, and hospital-based fieldwork) asked what mattered to 18 young adults primarily from racial-ethnic minority groups and 19 of their self-identified key supporters (N=37) as they made decisions about treatment during the 12-week critical period after an initial hospitalization for psychosis. The analytical approach used inductive coding and constructivist grounded theory methods to analyze interview transcripts and field notes from home visits and generate hypotheses about key factors that seemed to affect treatment decision making. Factors were ranked in order of frequency across all participants (overall, young adults only, and key supporters only). RESULTS Among the 37 total participants (young adults and key supporters), more than two-thirds were concerned with getting back to normal, the insufficient mental health care on offer, police involvement in their pathway to care, feeling worse, and needing help with repairing strained relationships. More than one-half were concerned with how young adults would be able to live independently in the future, paying for mental health care, distrusting mental health diagnoses, managing social pressure to use substances, feeling disempowered by hospitalization experiences, and managing transportation challenges. CONCLUSIONS To better engage young adults with early psychosis in care, including those from racial-ethnic minority groups, there is a need to design services that address the specific concerns of their everyday lives in the context of the initial hospitalization and posthospitalization period.
Collapse
Affiliation(s)
- Neely Myers
- Southern Methodist University, Department of Anthropology, Dallas, Texas
- University of Texas Southwestern Medical School, Department of Psychiatry, Dallas, Texas
| | - Anubha Sood
- University of Texas Southwestern Medical School, Department of Psychiatry, Dallas, Texas
| | - Katherine E. Fox
- Southern Methodist University, Department of Anthropology, Dallas, Texas
| | | | - Michael T. Compton
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA
| |
Collapse
|
28
|
Lal S, Malla A, Marandola G, Thériault J, Tibbo P, Manchanda R, Williams R, Joober R, Banks N. "Worried about relapse": Family members' experiences and perspectives of relapse in first-episode psychosis. Early Interv Psychiatry 2019; 13:24-29. [PMID: 28524541 DOI: 10.1111/eip.12440] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/19/2016] [Accepted: 01/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to gain an in-depth understanding on the subject of relapse from the perspectives of family members of young people receiving services for a first-episode psychosis (FEP). METHODS A qualitative descriptive approach, using focus group methods, was used to elicit experiences, understandings, and knowledge of relapse in FEP. Family members were recruited from 4 specialized early intervention programmes for psychosis in Canada. A total of 24 (6 male, 18 female) family members participated in the study. Thematic analysis was used to examine the data. RESULTS The core underlying theme in all focus groups was worrying about relapse, which was often accompanied by significant levels of fear and anxiety, and was influenced by: (1) impact of an episode of psychosis; (2) limited confidence in recognizing and coping with relapse; (3) unmet needs for coping skills and emotional support and (4) unmet needs regarding frequency and continuity of communication with clinicians. CONCLUSIONS Family members' unmet needs for relapse-focused education, support and communication with service providers and peers, can have a negative impact on relapse prevention. Addressing family members' education and support needs in a tailored manner (including preferences for types of peer support) can contribute positively to their confidence and ability to recognize and respond to relapse. This can help reduce fear and anxieties about relapse, and positively influence the ability to function as caregivers. Future research should focus on best approaches for providing education, sustained contact with the clinical team and family peer support.
Collapse
Affiliation(s)
- Shalini Lal
- School of Rehabilitation, University of Montreal, Québec, Canada.,Health Innovation and Evaluation Hub, University of Montreal's Hospital Research Centre (CRCHUM), Montréal, Québec, Canada.,PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Ashok Malla
- PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Gina Marandola
- PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Joanie Thériault
- School of Rehabilitation, University of Montreal, Québec, Canada
| | - Phil Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rahul Manchanda
- PEPP-London, London Health Sciences Centre, London, Ontario, Canada
| | - Richard Williams
- Victoria EPI Program, Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Ridha Joober
- PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Nicola Banks
- Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada
| |
Collapse
|
29
|
Gajwani R, Larkin M, Jackson C. "What is the point of life?": An interpretative phenomenological analysis of suicide in young menwith first-episode psychosis. Early Interv Psychiatry 2018; 12:1120-1127. [PMID: 28418116 DOI: 10.1111/eip.12425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/12/2016] [Accepted: 11/22/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lifetime risk of suicide in first-episode psychosis far exceeds the general population, with the risk of suicide persisting long after first presentation. There is strong evidence to suggest that women more frequently attempt suicide, while men are at a greater risk of completing suicide. First-hand experiential evidence is needed in order to better understand men's motives for, and struggles with, suicidality in early psychosis. METHODS Semi-structured interviews were conducted with 7 participants. The interviews explored each respondent's account of their suicide attempt within the broader context of their life, in relation to their past, present and future. In line with the exploratory, inductive nature of the study, an Interpretative Phenomenological Analysis was used to explore the meaning of suicide attempts in these accounts. RESULTS Three super-ordinate themes emerged: Self-as-vulnerable (intra- and inter-personal relationships), appraisal of cumulative life events as unbearable and meaning of recovery marked by shared sense of hope and imagery for the future. CONCLUSIONS Young men in the early stages of their treatment are seeking to find meaning for frightening, intrusive experiences with origins which often precede psychosis. These experiences permeate personal identity, relationships and recovery. Suicide was perceived as an escape from this conundrum, and was pursued angrily and impulsively. By contrast, the attainment of hope was marked by sharing one's burden and finding a sense of belonging. Specialized assertive outreach programmes may be beneficial in improving the social inclusion of young men who may be particularly marginalized.
Collapse
Affiliation(s)
- Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Larkin
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Chris Jackson
- Early Intervention Psychosis, Forward Thinking Birmingham, Birmingham, UK
| |
Collapse
|
30
|
Maddigan J, LeDrew K, Hogan K, Le Navenec CL. Challenges to recovery following early psychosis: Nursing implications of recovery rate and timing. Arch Psychiatr Nurs 2018; 32:836-844. [PMID: 30454625 DOI: 10.1016/j.apnu.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/30/2018] [Accepted: 06/02/2018] [Indexed: 12/21/2022]
Abstract
Early intervention in first episode psychosis is based on an indicated prevention approach that has early illness identification and timely recovery as primary goals. Nurses are instrumental in helping individuals and families achieve both aims. To better understand recovery following a first episode, a prospective cohort of 260 individuals participating in a three-year early intervention program was monitored for achievement of recovery outcomes. Two outcome measures were used to examine the recovery rate and timing of the cohort: (1) partial recovery was comprised of two criteria: (a) symptom control (psychosis and mania), and (b) daily functioning, and 2) comprehensive recovery was measured by three criteria: (a) symptom control; (b) daily functioning; and, (c) quality of life. Survival analysis, including the Kaplan-Meier statistic, and Cox hazard regression were used to examine the cohort's rate and timing for both measures. One hundred and seventy-four individuals attained partial recovery with half (51.1%) reaching the target within nine months. Comprehensive recovery was achieved by 59 individuals (22.7%), primarily in year two and three of treatment. Issues impacting quality of life delayed recovery for the majority of program participants. The gap between psychosis remission and satisfaction/fulfillment with one's everyday life is troubling, but could be improved with stronger nursing support and influence. Sharing the recovery experience with individuals and families that supports their life goals and the discovery of meaning, hope and purpose in the face of illness is the work of nurses. Suggestions for strengthening nursing's impact are considered.
Collapse
Affiliation(s)
| | - Kellie LeDrew
- Memorial University of Newfoundland, Canada; Eastern Regional Health Authority, Newfoundland, Canada
| | - Kevin Hogan
- Eastern Regional Health Authority, Newfoundland, Canada
| | | |
Collapse
|
31
|
Affiliation(s)
- Aubrey M. Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Nicholas J.K. Breitborde
- Departments of Psychiatry and Behavioral Health and Psychology, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
32
|
Corsico P, Griffin-Doyle M, Singh I. What constitutes 'good practice' in early intervention for psychosis? Analysis of clinical guidelines. Child Adolesc Ment Health 2018; 23:185-193. [PMID: 30197574 PMCID: PMC6120554 DOI: 10.1111/camh.12229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early Intervention in Psychosis (EIP) services have been implemented with the dual aims of preventing harmful outcomes associated with early-onset psychosis and improving prognosis. However, concerns have been raised regarding the ethical implications of involving young people in EIP services. One way to ensure high ethical standards and promote good practice in EIP delivery is through governance of clinical practice. This study aimed to investigate the normative dimensions of good practice in EIP through examination of clinical guideline documents published in England over the past 15 years. METHODS A total of 14 clinical guidelines and relevant policy documents for EIP were retrieved and analysed using a mixed inductive and deductive thematic approach. Themes were derived from the data itself, whereas the development of broader categories was performed through a constant comparison with the scientific literature describing ethical issues in EIP. RESULTS Ethical touchpoints of good practice in EIP included both procedural and substantive factors, which were seen to be interdependent and mutually constitutive. These ethical touchpoints were largely implicit in the documents analysed. Procedural requirements of EIP service delivery consisted of norms and rules pertaining to EIP service structure, adherence to codes of ethics, inclusivity, patient and family centredness and appropriate treatment provision. Substantive factors consisted of moral attributes that should be cultivated by healthcare professionals working in EIP: competency, empathy, sensitivity and trustworthiness. CONCLUSIONS We argue that, to ensure good practice in EIP, procedural and substantive ethical expectations embedded in EIP guideline documents should be made explicit in EIP service and care delivery. We suggest that the procedural and substantive factors highlighted in this paper contribute useful dimensions for the eventual evaluation of good practice in EIP services across England.
Collapse
Affiliation(s)
- Paolo Corsico
- Centre for Social Ethics and Policy School of Law The University of Manchester Manchester UK.,Department of Psychiatry University of Oxford Warneford Hospital Oxford UK
| | | | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities University of Oxford Oxford UK
| |
Collapse
|
33
|
O'Connor C, Kadianaki I, Maunder K, McNicholas F. How does psychiatric diagnosis affect young people's self-concept and social identity? A systematic review and synthesis of the qualitative literature. Soc Sci Med 2018; 212:94-119. [PMID: 30029092 DOI: 10.1016/j.socscimed.2018.07.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
Abstract
Receiving a psychiatric diagnosis in childhood or adolescence can have numerous social, emotional and practical repercussions. Among the most important of these are the implications for a young person's self-concept and social identity. To ensure diagnoses are communicated and managed in a way that optimally benefits mental health trajectories, understanding young people's first-hand experience of living with a diagnosis is paramount. This systematic review collates, evaluates and synthesises the qualitative research that has explored how psychiatric diagnosis interacts with young people's self-concept and social identity. A search of 10 electronic databases identified 3892 citations, 38 of which met inclusion criteria. The 38 studies were generally evaluated as moderate-to-high quality research. Thematic synthesis of their findings highlighted the multifaceted ways diagnosis affects young people's self-concept and social identity. Diagnosis can sometimes threaten and devalue young people's self-concept, but can also facilitate self-understanding, self-legitimation and self-enhancement. A diagnosis can lead to social alienation, invalidation and stigmatisation, yet can also promote social identification and acceptance. Further research is needed to clarify which self and identity outcomes can be expected in a given set of circumstances, and to establish how self and identity effects interact with diagnoses' other clinical, practical, social and emotional consequences.
Collapse
Affiliation(s)
- Cliodhna O'Connor
- School of Psychology, University College Dublin, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
| | | | - Kristen Maunder
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Fiona McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland; Our Lady's Children's Hospital Crumlin, Dublin, Ireland; Lucena Clinic, Rathgar, Dublin, Ireland
| |
Collapse
|
34
|
Stasiulis E, Gladstone B, Boydell K, O'Brien C, Pope E, Laxer RM. Children with facial morphoea managing everyday life: a qualitative study. Br J Dermatol 2018; 179:353-361. [PMID: 29451694 DOI: 10.1111/bjd.16449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Facial morphoea is a chronic inflammatory skin disorder, typically presenting in childhood and adolescence, which can be disfiguring, and which has been suggested to cause mild-to-moderate impairment in quality of life. OBJECTIVES To explore the everyday experiences of children with facial morphoea by examining the psychosocial impact of living with facial morphoea and how children and their families manage its impact. METHODS We used a qualitative, social constructionist approach involving focus groups, in-depth interviews and drawing activities with 10 children with facial morphoea aged 8-17 years and 13 parents. Interpretive thematic analysis was utilized to examine the data. RESULTS Children and parents reported on the stress of living with facial morphoea, which was related to the lack of knowledge about facial morphoea and the extent to which they perceived themselves as different from others. Self-perceptions were based on the visibility of the lesion, different phases of life transitions and the reactions of others (e.g. intrusive questioning and bullying). Medication routines, and side-effects such as weight gain, added to the stress experienced by the participants. To manage the impact of facial morphoea, children and their parents used strategies to normalize the experience by hiding physical signs of the illness, constructing explanations about what 'it' is, and by connecting with their peers. CONCLUSIONS Understanding what it is like to live with facial morphoea from the perspectives of children and parents is important for devising ways to help children with the disorder achieve a better quality of life. Healthcare providers can help families access resources to manage anxiety, deal with bullying and construct adequate explanations of facial morphoea, in addition to providing opportunities for peer support.
Collapse
Affiliation(s)
- E Stasiulis
- Child and Youth Mental Health Research Unit, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Science, Toronto, ON, Canada
| | - B Gladstone
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - K Boydell
- Child and Youth Mental Health Research Unit, The Hospital for Sick Children, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Black Dog Institute, University of South Wales, Randwick, NSW, Australia
| | - C O'Brien
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - E Pope
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - R M Laxer
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
35
|
Cabassa LJ, Piscitelli S, Haselden M, Lee RJ, Essock SM, Dixon LB. Understanding Pathways to Care of Individuals Entering a Specialized Early Intervention Service for First-Episode Psychosis. Psychiatr Serv 2018; 69:648-656. [PMID: 29493414 PMCID: PMC6007867 DOI: 10.1176/appi.ps.201700018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to understand the pathways to care from the onset of a first episode of psychosis to entry into a specialized early intervention service (EIS) for individuals with nonaffective psychosis. METHODS A sample of 20 individuals who participated in an EIS and ten of their family members were enrolled. Semistructured qualitative interviews were used to characterize participants' lives during the onset of psychosis and explore their help-seeking events from the onset of psychosis to entry into the EIS. Data were analyzed by using grounded theory and a case study methodology. RESULTS The median duration between the onset of psychosis and EIS entry was 4.5 months. A grounded model emerged from the analysis that captured how help-seeking decisions were influenced by the misattribution of symptoms, stigma, and self-reliance. These factors created a cloud of uncertainty in which individuals experiencing early psychosis and their family members struggled to make sense of what was happening, how and when to seek help, and what to expect from treatment. Contacts with the health care system were critical junctures in the pathway to care that could reduce or increase uncertainty and expedite or delay EIS entry. CONCLUSIONS Findings indicate that efforts to expedite EIS entry should focus on reducing the uncertainty that affected individuals and their family members face when seeking care by improving their experiences with mental health services.
Collapse
Affiliation(s)
- Leopoldo J Cabassa
- Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis. Ms. Piscitelli, Dr. Essock, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Essock and Dr. Dixon are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, where Ms. Haselden is affiliated. Dr. Lee is with the Lois V. and Samuel J. Silberman School of Social Work, Hunter College, New York
| | - Sarah Piscitelli
- Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis. Ms. Piscitelli, Dr. Essock, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Essock and Dr. Dixon are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, where Ms. Haselden is affiliated. Dr. Lee is with the Lois V. and Samuel J. Silberman School of Social Work, Hunter College, New York
| | - Morgan Haselden
- Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis. Ms. Piscitelli, Dr. Essock, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Essock and Dr. Dixon are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, where Ms. Haselden is affiliated. Dr. Lee is with the Lois V. and Samuel J. Silberman School of Social Work, Hunter College, New York
| | - Rufina J Lee
- Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis. Ms. Piscitelli, Dr. Essock, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Essock and Dr. Dixon are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, where Ms. Haselden is affiliated. Dr. Lee is with the Lois V. and Samuel J. Silberman School of Social Work, Hunter College, New York
| | - Susan M Essock
- Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis. Ms. Piscitelli, Dr. Essock, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Essock and Dr. Dixon are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, where Ms. Haselden is affiliated. Dr. Lee is with the Lois V. and Samuel J. Silberman School of Social Work, Hunter College, New York
| | - Lisa B Dixon
- Dr. Cabassa is with the George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis. Ms. Piscitelli, Dr. Essock, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Essock and Dr. Dixon are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, where Ms. Haselden is affiliated. Dr. Lee is with the Lois V. and Samuel J. Silberman School of Social Work, Hunter College, New York
| |
Collapse
|
36
|
Abstract
The first episode of psychosis often emerges during young adulthood, when individuals are pursuing important educational and career goals that can become derailed because of the development of major impairments. Past research has neglected the developmental nature of employment and education decisions that young adults with first-episode psychosis make within the context of their lives. The purpose of this grounded theory study was to advance a model of the career decision-making processes of young adults with first-episode psychosis, and the influences that affect their career decision-making. The career decision-making of young adults with first-episode psychosis emerged as a multistaged, iterative process that unfolded over three phases of illness, and was affected by several internal and environmental influences. These findings suggest the phase of illness and career decision-making stage should be considered in future vocational programming for young adults with first-episode psychosis.
Collapse
|
37
|
Jansen JE, Pedersen MB, Hastrup LH, Haahr UH, Simonsen E. Important first encounter: Service user experience of pathways to care and early detection in first-episode psychosis. Early Interv Psychiatry 2018; 12:169-176. [PMID: 26572931 DOI: 10.1111/eip.12294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long duration of untreated psychosis is associated with poor clinical and functional outcomes. However, few systematic attempts have been made to reduce this delay and little is known of service users' experience of early detection efforts. AIM We explored service users' experience of an early detection service and transition to specialized treatment service, including pathway to care, understanding of illness and barriers to adequate assessment and treatment. METHODS In-depth interviews were conducted with 10 service users (median age 21, range 18-27, five males and five females) who were diagnosed with a first-episode non-affective psychosis and who were seen by an early detection team (TOP) and currently enrolled in a specialized early intervention service for this disorder (OPUS). RESULTS Stigma and fear of the 'psychiatric system' were reported as significant barriers to help seeking, while family members were seen as a crucial support. Moreover, the impact of traumatic events on the experience and development of psychosis was highlighted. Finally, participants were relieved by the prospect of receiving help and the early detection team seemed to create a trusting relationship by offering a friendly, 'anti-stigmatized' space, where long-term symptomatology could be disclosed through accurate and validating questioning. CONCLUSIONS Early detection services have two important functions. One is to make accurate assessments and referrals. The other is to instil hope and trust, and to facilitate further treatment by forming an early therapeutic alliance. The findings in this study provide important insights into the way in which early detection efforts and pathways to care are experienced by service users, with direct implications for improving psychiatric services.
Collapse
Affiliation(s)
- Jens Einar Jansen
- Psychiatric Research Unit, Psychiatry Region Zealand, Copenhagen, Denmark.,Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Denmark
| | - Marlene Buch Pedersen
- Psychiatric Research Unit, Psychiatry Region Zealand, Copenhagen, Denmark.,Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Denmark
| | | | - Ulrik Helt Haahr
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
38
|
Lal S, Ungar M, Malla A, Leggo C, Suto M. Impact of Mental Health Services on Resilience in Youth with First Episode Psychosis: A Qualitative Study. Adm Policy Ment Health 2018; 44:92-102. [PMID: 26604203 DOI: 10.1007/s10488-015-0703-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this qualitative study is to understand how mental health and related services support and hinder resilience in young people diagnosed with first-episode psychosis. Seventeen youth between the ages of 18-24 were recruited and 31 in-depth interviews were conducted. Findings illustrated that informational and meaning making, instrumental, and emotional supports were experienced positively (i.e., resilience-enhancing); whereas services with ghettoizing, engulfing, regulating, and out of tune practices were experienced negatively (i.e., resilience-hindering). These results demonstrate how various types of service-related practices influence resilience in youth and can inform future planning of services for psychosis.
Collapse
Affiliation(s)
- S Lal
- School of Rehabilitation, University of Montreal, Montreal, Canada. .,University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada. .,Douglas Mental Health University Institute, Montreal, Canada.
| | - M Ungar
- School of Social Work, Dalhousie University, Halifax, Canada
| | - A Malla
- Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - C Leggo
- Department of Language and Literacy Education, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - M Suto
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| |
Collapse
|
39
|
Moritz S, Mahlke CI, Westermann S, Ruppelt F, Lysaker PH, Bock T, Andreou C. Embracing Psychosis: A Cognitive Insight Intervention Improves Personal Narratives and Meaning-Making in Patients With Schizophrenia. Schizophr Bull 2018; 44:307-316. [PMID: 29106693 PMCID: PMC5814991 DOI: 10.1093/schbul/sbx072] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Schizophrenia is a complex psychiatric disorder with unknown and presumably heterogeneous etiology. While the disorder can have various outcomes, research is predominantly "deficit-oriented" emphasizing the hardship that the disorder inflicts on sufferers as well as their families and society. Beyond symptom reduction, imparting patients with hope and meaning in life is increasingly considered an important treatment target, which may raise self-esteem, and reduce self-stigma and suicidal ideation. The present study compared a psychotherapeutic treatment aimed at improving cognitive insight, individualized metacognitive intervention (MCT+), with an active control in order to elucidate if personal meaning-making and hope can be improved in patients with psychosis across time. A total of 92 patients were randomized to either individualized metacognitive therapy (MCT+) or CogPack (neuropsychological training) and followed up for up to 6 months. The "Subjective Sense in Psychosis Questionnaire" (SUSE) was administered which covers different salutogenetic vs pathogenetic views of the disorder, valence of symptom experiences and the consequences of psychosis. Patients in the MCT+ group showed a significant positive shift in attitudes towards the consequences of their illness over time relative to patients in the active control condition. There was some evidence that MCT+ also enhanced meaning-making. The perceived negative consequences of psychosis were highly correlated with depression and low self-esteem, as well as suicidality. The study shows that a cognitive insight training can improve meaning-making in patients and help them come to terms with their diagnosis.
Collapse
Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Candelaria I Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Friederike Ruppelt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center and The Indiana University School of Medicine, Indianapolis, IN
| | - Thomas Bock
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| |
Collapse
|
40
|
Shoesmith WD, Borhanuddin AFBA, Yong Pau Lin P, Abdullah AF, Nordin N, Giridharan B, Forman D, Fyfe S. Reactions to symptoms of mental disorder and help seeking in Sabah, Malaysia. Int J Soc Psychiatry 2018; 64:49-55. [PMID: 29103338 DOI: 10.1177/0020764017739643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A better understanding is needed about how people make decisions about help seeking. MATERIALS Focus group and individual interviews with patients, carers, healthcare staff, religious authorities, traditional healers and community members. DISCUSSION Four stages of help seeking were identified: (1) noticing symptoms and initial labelling, (2) collective decision-making, (3) spiritual diagnoses and treatment and (4) psychiatric diagnosis and treatment. CONCLUSION Spiritual diagnoses have the advantage of being less stigmatising, giving meaning to symptoms, and were seen to offer hope of cure rather than just symptom control. Patients and carers need help to integrate different explanatory models into a meaningful whole.
Collapse
Affiliation(s)
- Wendy Diana Shoesmith
- 1 Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | | | - Pauline Yong Pau Lin
- 3 Faculty of Humanities, Arts and Heritage, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Ahmad Faris Abdullah
- 1 Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | | | | | - Dawn Forman
- 6 Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Sue Fyfe
- 6 Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| |
Collapse
|
41
|
Hansen H, Stige SH, Davidson L, Moltu C, Veseth M. How Do People Experience Early Intervention Services for Psychosis? A Meta-Synthesis. Qual Health Res 2018; 28:259-272. [PMID: 29039239 DOI: 10.1177/1049732317735080] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We conducted a study to explore how people diagnosed with first-episode psychosis experienced their contact with early intervention services for psychosis and the way these experiences relate to their recovery processes. Our aim was to integrate and describe the service users' experiences in a rigorous and comprehensive way. A broad literature search was performed in June and July 2016. After screening, 17 qualitative studies were included. We analyzed the findings in two main steps: (a) translating studies into one another and (b) synthesizing the findings from the studies. Through these interpretative processes, we found five new and overarching themes: (a) something is wrong, (b) do for myself, (c) it's about people, (d) a price to pay, and (e) ongoing vulnerability. We describe these themes as a process that service users' maneuver through in their contact with the services. Our findings are discussed in light of relevant research.
Collapse
Affiliation(s)
- Hege Hansen
- 1 Western Norway University of Applied Sciences, Bergen, Norway
| | | | | | | | | |
Collapse
|
42
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
43
|
Abstract
Recently, health policy in the UK has begun to engage with the concept of 'parity of esteem' between physical and mental healthcare. This has led one recent initiative to improve service provision for first episode psychosis, which aims to bring it into line with some of the principles underpinning good practice in cancer care. In this paper, we consider some of the metaphorical consequences of likening psychosis to cancer. While we find the comparison unhelpful for clinical purposes, we argue that it can be a helpful lens through which to examine service provision for psychosis in young people. Through this lens, specialist community-based services would appear to compare reasonably well. Inpatient care for young people with psychosis, on the other hand, suffers very badly by comparison with inpatient facilities for teenage cancer care. We note some of the many positive features of inpatient cancer care for young adults, and-drawing upon previous research on inpatient psychiatric care-observe that many of these are usually absent from mental health facilities. We conclude that this metaphor may be a helpful rhetorical device for communicating the lack of 'parity of esteem' between mental and physical healthcare. This inequity must be made visible in health policy, in commissioning, and in service provision.
Collapse
Affiliation(s)
| | - Zoë Boden
- London South Bank University, London, UK
| | | |
Collapse
|
44
|
Jordan G, Pope M, Lambrou A, Malla A, Iyer S. Post-traumatic growth following a first episode of psychosis: a scoping review. Early Interv Psychiatry 2017; 11:187-199. [PMID: 27189806 DOI: 10.1111/eip.12349] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 03/03/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
AIM A first-episode psychosis (FEP) is a traumatic experience that can often result in great suffering. However, in addition to suffering, persons affected by FEP may also experience post-traumatic growth (PTG) or the perception that good has followed psychosis. Although much is known concerning the negative outcomes following FEP, little attention has been given to the state of scientific knowledge on PTG following FEP. The aim of this study is to determine the state of knowledge concerning PTG following FEP to help set the stage for a full systematic review. METHODS A scoping review was conducted following six steps: identifying the research question and relevant studies, selecting studies, charting the data, coding and summarizing results and consulting with relevant stakeholders regarding the findings. RESULTS Post-traumatic growth following FEP was described mostly as following the process of recovery and primarily, in qualitative articles. Themes related to PTG included developing positive character traits, making positive lifestyle changes, developing stronger connections with others, integrating the FEP with the self, experiencing greater religiosity and appreciating life more. CONCLUSIONS In addition to the negative aftermath of FEP, PTG may also occur. Evidence of PTG following FEP will be examined in a systematic review focused on the recovery and qualitative literature.
Collapse
Affiliation(s)
- Gerald Jordan
- Prevention and Early Intervention Program for Psychoses, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Megan Pope
- Prevention and Early Intervention Program for Psychoses, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Angella Lambrou
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychoses, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,ACCESS Open Minds, Montreal, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya Iyer
- Prevention and Early Intervention Program for Psychoses, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,ACCESS Open Minds, Montreal, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| |
Collapse
|
45
|
Abstract
This study aims to understand the process of change in self and its relationship to recovery in the first 3 months following first-episode psychosis (FEP). Because psychosis is understood as a disorder of self, theories of self are needed to consider how sense of self is affected and restored. The authors used semistructured interviews to explore the experiences of 12 young people who had been diagnosed with FEP. The interviews were conducted at two time points: during the first month following the onset of psychosis and 3 months later. The authors employed Interpretive Phenomenological Analysis to explicate interview data and explore the experience of change following FEP. Themes that emerged in the data came under two superordinate themes: loss of self and strengthening of self. Dialogical theory of self was used to interpret the findings and explore the relationship between sense of self and recovery for young people during this critical phase following FEP.
Collapse
|
46
|
Sedláková H, Řiháček T. The Incorporation of a Spiritual Emergency Experience Into a Client’s Worldview: A Grounded Theory. Journal of Humanistic Psychology 2016; 59:877-97. [DOI: 10.1177/0022167816668114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study is focused on the process of constructing the meaning of a spiritual emergency experience. In the context of this study, spiritual emergency is understood as an experience of psychotic nature, defined by criteria such as good preepisode functioning, nonordinary states of consciousness, awareness of the intrapsychic nature of the process, or preserved ability to cooperate. In-depth interviews with 13 participants who experienced an episode of spiritual emergency were analyzed using the grounded theory method. The analysis yielded a core category titled “The incorporation of a spiritual emergency experience into a client’s worldview.” The process of incorporation was conceptualized by two complementary paths: (a) a Suppressive path characterized by an effort to mitigate or eliminate symptoms, considering them as a personally meaningless pathology, and return to a previous state of functioning and (b) a Facilitative path characterized by an acceptance of symptoms, a search for their meaning, and eventually, the adoption of a new perspective. The results are discussed in relation to different theoretical approaches to psychotic experiences.
Collapse
|
47
|
Chen FP, Gearing RE, DeVylder JE, Oh HY. Pathway model of parental help seeking for adolescents experiencing first-episode psychosis. Early Interv Psychiatry 2016; 10:122-8. [PMID: 24894667 DOI: 10.1111/eip.12159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 04/29/2014] [Indexed: 11/30/2022]
Abstract
AIM Parents and caregivers are confronted with many challenges when caring for adolescents experiencing first-episode psychosis (FEP). Understanding and support for parental help-seeking process is essential for adolescents' timely access to treatment. The study aimed to develop a pathway model of parental help seeking for adolescents experiencing FEP and identify crucial time points for intervention. METHODS Directed content analysis was conducted on semi-structured qualitative interviews of 16 parents whose children had experienced FEP and focused on parents' experiences prior to and during FEP until first hospitalization. RESULTS The resultant parental help seeking for FEP model included two stages and six phases. The contemplation stage is composed of phases of initial awareness, recognizing severity and considering options. The action stage entailed help-seeking intention, securing help and service appraisal. All parents promptly began help seeking after recognizing severe symptoms and sought advice from professional and community supports, although parents' lack of initial awareness was common. Further analysis on individual parents' help-seeking trajectories showed that among the 50% parents who reported pre-existing childhood conditions, 87.5% did not report initial awareness of psychotic symptoms. CONCLUSIONS Findings recommend intervention at three specific periods of help seeking. First, psychoeducation is needed when parents first engage with health care for their children's disabling conditions. Professionals treating childhood conditions need training to vigilantly monitor the overall mental health of the children over time. Second, it is important to enhance the roles of formal and informal community resources in facilitating parental help seeking. Finally, family-focused interventions are essential in supporting the family for securing needed treatment.
Collapse
Affiliation(s)
- Fang-pei Chen
- School of Social Work, Columbia University, New York, New York, USA
| | - Robin E Gearing
- School of Social Work, Columbia University, New York, New York, USA
| | | | - Hans Y Oh
- School of Social Work, Columbia University, New York, New York, USA
| |
Collapse
|
48
|
Abstract
In this study, we aim to describe the pathways to care for patients with first-episode psychosis in Singapore. We analyzed data from 900 individuals accepted by the Singapore Early Psychosis Intervention Programme between 2007 and 2012. The most common first contacts were specialist care (59%), primary care (27%), and the police (12%). Multivariate regression models showed that first contact with services varied according to demographic variables and diagnosis. The duration of untreated psychosis, total number of contacts before referral, and rate of referral to the Early Psychosis Intervention Programme varied according to demographic and clinical variables and first contact. We hope that this information will enable clinicians, managers, and other service providers to target interventions to streamline referrals, reduce distress, and improve the treatment of young people with psychotic illnesses.
Collapse
|
49
|
Myers NAL, Ziv T. "No One Ever Even Asked Me that Before": Autobiographical Power, Social Defeat, and Recovery among African Americans with Lived Experiences of Psychosis. Med Anthropol Q 2016; 30:395-413. [PMID: 26990015 DOI: 10.1111/maq.12288] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 11/27/2022]
Abstract
Our article draws on ethnographic research with African American males diagnosed with a psychotic disorder in a high-poverty urban area of the northeastern United States. Our participants frequently described the ways public mental health services led them to experience a paralyzing erosion of autobiographical power, which we define as the ability to tell one's own story and be the editor of one's own life. We identified three important points when the loss of autobiographical power seemed to perpetuate social defeat or a sense of social powerlessness (Luhrmann 2007) for our participants during their interactions with public mental health care. We invite further inquiry into the loss of autobiographical power in settings of public mental health care, the sense of social defeat it seems to perpetuate, and the impact of these on mental health recovery, especially for people living in contexts of persistent social adversity.
Collapse
Affiliation(s)
| | - Tali Ziv
- University of Pennsylvania, Department of Anthropology
| |
Collapse
|
50
|
Jansen JE, Pedersen MB, Trauelsen AM, Nielsen HG, Haahr UH, Simonsen E. The Experience of Childhood Trauma and Its Influence on the Course of Illness in First-Episode Psychosis: A Qualitative Study. J Nerv Ment Dis 2016; 204:210-6. [PMID: 26675249 DOI: 10.1097/NMD.0000000000000449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Persons with schizophrenia spectrum disorders often report high levels of childhood trauma, which often exacerbates symptoms and impede the process of recovery. However, little is known about how these traumas are experienced by service users and how they are integrated in their life stories. To examine this, we conducted in-depth interviews with 15 service users with a diagnosis of a first-episode nonaffective psychosis who had reported 1 or more childhood traumas in self-report measures. There was an unexpected discrepancy between the number of traumas reported in self-report measures and in semistructured interviews, and many of the traumas did not seem integrated in their personal narratives. The analyses further revealed that although participants often described complicated and traumatic childhood environments, they still felt supported by their families; they reported a range of ways in which they tried to cope with and gain control of their psychotic disorder, and they described a general optimistic view of the future.
Collapse
|