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Wiesepape CN, Smith EA, Hillis-Mascia JD, Queller Soza SE, Morris MM, James AV, Stokes A. Metacognition as a Transdiagnostic Determinant of Recovery in Schizotypy and Schizophrenia Spectrum Disorders. Behav Sci (Basel) 2024; 14:336. [PMID: 38667132 PMCID: PMC11047686 DOI: 10.3390/bs14040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/24/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
The term schizotypy refers to the latent personality organization that is thought to underpin the liability to develop schizophrenia and associated disorders. Metacognition, or the ability to understand and form increasingly complex and integrated ideas of oneself, others, and one's community, has been proposed to be an important transdiagnostic construct across schizophrenia spectrum disorders and a range of both clinical and non-clinical manifestations of schizotypy. In this paper, we review evidence that deficits in metacognition are present in individuals with relatively high levels of schizotypy and that these deficits are related to symptomology, function, and quality of life. We address the idea that decrements in metacognition may also contribute to the progression from schizotypy to more severe manifestations, while the amelioration of these deficits may enhance aspects of recovery, including the ability to form an integrated sense of self, others, and the wider world. We also review the following two recovery-oriented psychotherapies that target metacognition to promote recovery in individuals with clinical manifestations of schizotypy: Evolutionary Systems Therapy for Schizotypy (ESTS) and Metacognitive Reflection and Insight Therapy (MERIT).
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Affiliation(s)
- Courtney N Wiesepape
- Austin VA Clinic, Veterans Affairs Central Texas Health Care, Austin, TX 78744, USA
| | - Elizabeth A Smith
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
| | | | | | - Madyson M Morris
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | | | - Alexis Stokes
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
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Barak Y, Sajjadi SF, Hobbs L, Patterson T. Functional recovery in older adults with schizophrenia: A national interRAI study. Int J Soc Psychiatry 2024:207640241230837. [PMID: 38366918 DOI: 10.1177/00207640241230837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
BACKGROUND The concept of recovery for people with schizophrenia (PwS) is still a matter of debate. Growing numbers of PwS living to older age calls for examination of their disease trajectories with a focus on recovery. AIM To compare two groups of PwS (good wellbeing; poor wellbeing) on several psychosocial variables associated with social wellbeing to identify interventions that support functional recovery. METHOD Data was drawn from participants from across New Zealand (NZ), who had received a formal diagnosis of Schizophrenia; were living independently in the community, and who had undergone their first International Resident Assessment Instrument (interRAI) assessment from 2012 to 2022. We compared two groups of PwS (good social wellbeing; poor social wellbeing) examining associations with demographic and psychosocial variables. RESULTS We compared interRAI assessments for: 'poor psychosocial wellbeing' (n = 1,378; 67%; 56% female; 70.5% 65 years and over; 36.1% never married); and 'good psychosocial wellbeing' (n = 693; 33%; 61.1% female; 78.1% 65 years and over; 29.8% never married; n = 549 did not have sufficient social wellbeing data to be included). We found significant associations between social wellbeing and depression, disruptive behaviour, decision making, self-expression, understanding verbal information, activity level, self-reported health and medication adherence. Logistical regression showed depression (β = .84, p < .001, Wald = 51.01, Exp(B) = 2.31) and mild disruptive behaviour (β = .63, p = .002, Wald = 9.26, Exp(B) = 0.53) were the only predictors of poor social wellbeing. Those who reported some degree of depressive symptoms were 2.31 (CI [1.84, 2.91]) more likely to be in the poor social wellbeing group. CONCLUSIONS A significant minority (33.5%) of older PwS enjoy positive social wellbeing. Several psychosocial variables are associated with wellbeing. By addressing the comorbidity of depressive symptoms, we may be able to improve wellbeing for older PwS.
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Affiliation(s)
- Yoram Barak
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - S Fatemeh Sajjadi
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Linda Hobbs
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Tess Patterson
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand
- Optentia Research Focus Area, North-West University, Potchefstroom, South Africa
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de Bruijn E, Jochems EC, Wierdsma AI, Voskes Y. The Overlooked Part of Flexible Assertive Community Treatment-A Retrospective Study on Factors Related to Discharge from FACT for Clients with a Psychotic Disorder. Community Ment Health J 2023; 59:1313-1320. [PMID: 37086300 PMCID: PMC10447266 DOI: 10.1007/s10597-023-01115-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/08/2023] [Indexed: 04/23/2023]
Abstract
Flexible assertive community treatment (FACT) is a recovery-based treatment and its manual describes discharge criteria for clients who are recovered. Yet research on discharge is lacking. In this retrospective and observational study, between 2009 and 2019, we explored how sociodemographic, clinical, and treatment factors are associated with planned discharge or no discharge. We included 1734 clients with a psychotic disorder of which 38.5% were discharged after a mutual decision that FACT was no longer necessary. Logistic regression analysis was used to create a discharge profile which was more favorable for discharged clients. They were older at the start of FACT, had lower HoNOS scores, were diagnosed with another psychotic disorder, and had fewer contacts with non-FACT members. Discharge is a part of FACT and is more common than anticipated. While this study provides preliminary answers, further research is necessary to better understand discharge and its associated factors.
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Affiliation(s)
- Eva de Bruijn
- GGZ Breburg, Tilburg, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | | | | | - Yolande Voskes
- GGZ Breburg, Tilburg, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
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Vázquez-Reyes A, Martín-Rodríguez A, Pérez-San-Gregorio MÁ, Vázquez-Morejón AJ. Survival of patients with severe mental disorders: Influence of social functioning. Int J Soc Psychiatry 2023; 69:1157-1165. [PMID: 36708399 DOI: 10.1177/00207640231152201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Patients with severe mental disorders have a high risk of premature death due to the interaction of various factors. Social functioning is a strategic functional factor in understanding the course of psychotic disorders. AIM Analyze the relationship between social functioning and its various dimensions and survival during a 10-year follow-up. METHOD The Social Functioning Scale (SFS) was administered to 163 close relatives of patients under treatment at a Community Mental Health Unit. Survival was described by Kaplan-Meier analysis and any differences in survival by level of social functioning were found by long-rank analysis. Finally, Cox regression was used to predict premature mortality. RESULTS Significant differences in mortality were identified in the interpersonal behavior dimension of social functioning, while there were no significant gender or diagnostic differences in the rest of the dimensions. The interpersonal behavior dimension and age were found to be factors predicting premature death. CONCLUSION These findings show the protective effect of social functioning retained by patients with psychotic disorders on their survival, and the need to apply evidence-based psychotherapy focused on recovery of social functioning in the early stages of the disorder.
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Affiliation(s)
| | - Agustín Martín-Rodríguez
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment. University of Seville, Seville, Spain
| | - María Ángeles Pérez-San-Gregorio
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment. University of Seville, Seville, Spain
| | - Antonio J Vázquez-Morejón
- Mental Health Service, University Hospital Virgen del Rocío, Seville, Spain
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment. University of Seville, Seville, Spain
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Murphy J, Mulcahy H, Mahony JO, Bradley S. Exploring individuals' experiences of hope in mental health recovery: An interpretative phenomenological analysis. J Psychiatr Ment Health Nurs 2023; 30:101-109. [PMID: 35403323 DOI: 10.1111/jpm.12833] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/24/2021] [Accepted: 03/28/2022] [Indexed: 01/13/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The delivery of mental health recovery orientated acre is a requirement of mental health professionals and an acknowledged desired outcome for individuals presenting with mental health issues. Hope has been recognized as one of 5 key processes of mental health recovery, and critically as the key catalyst of recovery. Mental health nurses are required to be competent in cultivating service user hope. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Novel exploration of how people described and made sense of the lived experience of hope in mental health recovery. Participants described hope as intrinsic to life in the context of its ability to cultivate desire and provide energy for life and living. Participants with experience of attempts to end life had a very clear concept of hope as missing at these times. Participants described the concept of hope as present but hidden to explain their survival through tortuous circumstances. The themes generated contribute to a greater understanding of the dynamic role and process of hope in mental health recovery. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Mental health practitioners need to be competent in understanding and cultivating hope as part of a person-centred approach, embedded in a therapeutic relationship. All stakeholders including service users, mental health nurses and educators need a more accessible reified dialogue of "hope" that harnesses its therapeutic potential. ABSTRACT: Introduction Mental health services have embraced the philosophy and practice of recovery. Research has confirmed hope as a micro-process of recovery. The lived experience of hope has received scant attention. This is required to improve understanding and optimize its therapeutic potential. Aim To explore how individuals describe and make sense of their experience of hope in mental health recovery. Method A qualitative interpretative phenomenological analysis (IPA) approach was used. The sample was accessed via email networks. Data were generated through semi-structured interviews and analysed using an IPA framework. Results Three superordinate themes emerged: "Without it we would wither up and die"-Hope as intrinsic to life; "I will be ok"-Having a sense of possibility and "Making it happen"-Moving forward. Individuals referenced hope by its absence when attempts were made to end life, and as present but hidden in tortuous circumstances. Discussion Individuals were more familiar with the concept of hopelessness, had a ready-to-hand vocabulary of "having no hope" and used this by default to inform what hope meant. Implications for Practice It is important that all stakeholders appreciate the context specific interpretation of hope and cultivate dialogue and understanding to harness its therapeutic potential.
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Affiliation(s)
- Joan Murphy
- University College Cork, Cork, Ireland.,Munster Technological University, Kerry Campus, Traleeee, Co. Kerry, Ireland
| | - Helen Mulcahy
- College Lecturer School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - James O' Mahony
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Stephen Bradley
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland.,Faculty of Lifelong Learning, IT Carlow, Carlow, Ireland
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Eiroa-Orosa FJ, Sánchez-Moscona C. Implementing the figure of peer support workers in mental health: an international perspective from the context of its implementation in Catalonia. Salud Colect 2023; 19:e4252. [PMID: 37311138 DOI: 10.18294/sc.2023.4252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/29/2022] [Indexed: 01/24/2023] Open
Abstract
In the context of debates surrounding the training of mental health peer support workers and their incorporation into the Catalan Health System, this article presents a literature review complemented by interviews carried out between 2020 and 2021 with both international and Spanish experts. Based on the information obtained, content analysis of elements of their training and integration within the health system was performed. German-speaking countries offer the most homogeneous training and recruitment programs. In the case of English- and French-speaking countries, non-profit or third sector organizations are usually in charge of training programs and recruitment. Various experiences with training programs exist in the Ibero-American world, although they are not recognized as professional qualifications. Recommendations are offered for the development of this figure in Catalonia, which include advancing towards professional training with recognition as health care providers, as well as contracting options from both socio-health or health care providers or from third sector entities.
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Affiliation(s)
- Francisco José Eiroa-Orosa
- Doctor en Psicología Clínica y Psiquiatría. Investigador Ramón y Cajal, Sección de Personalidad, Evaluación y Tratamiento Psicológico, Departamento de Psicología Clínica y Psicobiología, Universidad de Barcelona. Integrante, Grupo de Investigación en Salud Mental en Primera Persona, Federación Veus, Barcelona, España
| | - Cecilia Sánchez-Moscona
- Magíster en Psicología General Sanitaria. Sección de Personalidad, Evaluación y Tratamiento Psicológico; Departamento de Psicología Clínica y Psicobiología, Universidad de Barcelona. Integrante, Grupo de Investigación en Salud Mental en Primera Persona, Federación Veus, Barcelona, España
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7
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Vázquez-Reyes A, Ángeles Pérez-San-Gregorio M, Martín-Rodríguez A, Vázquez-Morejón AJ. Ten-year follow-up of social functioning and behaviour problems in people with schizophrenia and related disorders. Int J Soc Psychiatry 2022; 68:1324-1335. [PMID: 34096361 DOI: 10.1177/00207640211023083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In recent years, several variables in the course of schizophrenia and related psychotic disorders have been studied. However, an instrumental analysis of the evolution of social functioning and behaviour problems has scarcely been explored. AIM To analyse the evolution of social functioning and behaviour problems and find any diagnosis or gender differences. METHOD The Social Functioning Scale (SFS) and the Behaviour Problems Inventory (BPI) were administered in Stages I (2003-2007) and II (2014-2017) to 100 close relatives of patients under treatment at a Community Mental Health Unit. A related samples t-test, analysis of variance and multivariate analysis of variance were performed to study the evolution and differences in social functioning and behaviour problems. Then a stepwise multiple linear regression analysis was done to predict the evolution of social functioning. RESULTS No deterioration in the evolution of social functioning or behaviour problems was observed, and schizophrenia patient scores were lower. Women scored higher in withdrawal/social engagement, interpersonal behaviour, independence-performance, independence-competence and total social functioning, with no significant differences in behaviour problems. Previous social functioning, underactivity/social withdrawal and education are predictive factors in the evolution of social functioning. Conclusion: The results show the need for implementing psychosocial intervention programs that promote functional recovery and keep problems from becoming chronic.
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Affiliation(s)
| | - María Ángeles Pérez-San-Gregorio
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - Agustín Martín-Rodríguez
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - Antonio J Vázquez-Morejón
- Mental Health Service, University Hospital Virgen del Rocío, Seville, Spain.,Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
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Layman DM, Fisher CB. Profiles of Psychological Strengths on Symptom Distress, Recovery, and Quality of Life Among Young Adults with a History of Adolescent Psychiatric Hospitalization. Community Ment Health J 2022; 58:1279-1296. [PMID: 35066736 DOI: 10.1007/s10597-022-00936-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Abstract
The current study surveyed 166 young adults (ages 20-35) with a history of adolescent psychiatric hospitalization to identify profiles of psychological strengths (self-determination, identity commitment, and low mental health self-stigma) and to examine their association with symptom distress, recovery, and quality of life in young adulthood. Over half of all participants (51%) reported a high quality of life, and over one-third (40%) were not experiencing clinically-significant psychiatric symptoms. k-means cluster analysis identified three distinct profiles: low psychological strengths, mixed, and high strengths. Multiple regression analyses indicated the high strengths profile was significantly associated with lower symptom distress, higher recovery, and higher quality of life after controlling for demographics, psychiatric history, treatment experience, and psychiatric interference in school and relationships during adolescence. Findings have implications for targeted support and services based on psychological profile, including family support, interventions to support medication management such as shared decision-making, and peer support.
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Affiliation(s)
- Deborah M Layman
- Psychology Department, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, USA.
| | - Celia B Fisher
- Psychology Department, Fordham University, 441 E. Fordham Road, Bronx, NY, 10458, USA
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9
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Recovery-Focused Metacognitive Interpersonal Therapy (MIT) for Adolescents with First-Episode Psychosis. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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10
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Ketola J, Jahangiri E, Hakko H, Riipinen P, Räsänen S. Assisted living for mentally ill-a systematic literature review and its recommendations. Nord J Psychiatry 2022; 76:403-422. [PMID: 34962222 DOI: 10.1080/08039488.2021.2001568] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The reduction in psychiatric hospital beds in the past decades has created a need for assisted living (AL). Even though AL is widely used, studies on it are scarce. AIMS To identify (1) study characteristics of the reviewed articles, (2) characteristics of inhabitants and characteristics of different types of AL, (3) financial costs in different types of AL, (4) the individual outcomes in AL inhabitants and quality of care. METHODS A systematic literature review on AL for the mentally ill focusing on inhabitant and AL features and their costs was conducted. Articles written in English from January 2000 to June of 2020, concerning adults were included. Simple Taxonomy of Supported Housing (STAX-SA) was applied and used for categorizing types of AL. RESULTS Twenty-five papers met our criteria. The majority of inhabitants were unemployed single male with psychotic disorders. The type of AL is mainly categorized according to staffing, provided support, and housing arrangement. In UK ALs with moderate support (STAX-SA 2-3) had the best quality of care while ALs with low support (STAX-SA 4) was the cheapest. Quality of care was better in small units with preset expected length of stay for inhabitants. Hospital treatment was significantly more expensive than any type of AL. Living in AL improved quality of life compared to hospital treatment, also psychiatric symptoms were reduced. CONCLUSION There is an evident need for evidence-based studies in a longitudinal comprehensive manner that evaluates different AL types, function of the inhabitants, and costs with respect to the quality of AL and care and outcome.
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Affiliation(s)
- Joel Ketola
- Research Unit of Clinical Neurosciences, Department of Psychiatry (OYS), University of Oulu, Psychiatry Oulu University Hospital, Oulu, Finland
| | - Erfan Jahangiri
- Research Unit of Clinical Neurosciences, Department of Psychiatry (OYS), University of Oulu, Psychiatry Oulu University Hospital, Oulu, Finland
| | - Helinä Hakko
- Research Unit of Clinical Neurosciences, Department of Psychiatry (OYS), University of Oulu, Psychiatry Oulu University Hospital, Oulu, Finland
| | - Pirkko Riipinen
- Research Unit of Clinical Neurosciences, Department of Psychiatry (OYS), University of Oulu, Psychiatry Oulu University Hospital, Oulu, Finland
| | - Sami Räsänen
- Research Unit of Clinical Neurosciences, Department of Psychiatry (OYS), University of Oulu, Psychiatry Oulu University Hospital, Oulu, Finland
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Baltazar L, De Benedictis L, Abdel-Baki A, Lalonde P, Lesage A. Long term course and outcome of first episode schizophrenia: a 27-to-31-year follow-up. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1319-1328. [PMID: 34762145 DOI: 10.1007/s00127-021-02185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe long term clinical and functional outcomes of schizophrenia in a developed country. METHOD Long term longitudinal study of clinical and functional outcomes of incidence cohort of all consecutive admissions for a first hospitalization for schizophrenia between 1983 and 1987 in Montreal, Canada (n = 142). Data collection was conducted at admission, 5 years, 10-16 years and 27-31 years follow-up by reviewing hospital charts and government linked health administrative databases. RESULTS One fifth of patients were never re-hospitalized and 35% were still in contact with the same catchment area psychiatric services. Thirty-four (24%) died on average at 45.5 years. Fourteen (9.9%) died by suicide; half of them did so 10 years after their first hospitalization. Over 20% were exposed to clozapine and nearly 50% to long-acting injectable antipsychotic medication. There were no inmates; an estimated one fifth might be inferred to be living in supervised residential settings and the rest lived alone or with family. Approximately three quarters of the patients under 65 were receiving social assistance benefits at study's end. From 15 to 25% might have been employed (supported or competitive employment). CONCLUSION This study confirms that the long-term course of schizophrenia is heterogenous and mostly positive with most patients living in the community, although a significant proportion need long term support and an important proportion experience premature death. To mitigate the persistent suicide risk and to respond to their need for support, continuous mental health professional's involvement is required for many.
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Affiliation(s)
- Lori Baltazar
- Hôpital Rivières des Prairies, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada. .,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, 7401 rue Hochelaga, Montréal, Québec, H1N 3M5, Canada.
| | - Luigi De Benedictis
- Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
| | - Amal Abdel-Baki
- Centre Hospitalier Universitaire de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
| | - Pierre Lalonde
- Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
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12
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Stone WS, Phillips MR, Yang LH, Kegeles LS, Susser ES, Lieberman JA. Neurodegenerative model of schizophrenia: Growing evidence to support a revisit. Schizophr Res 2022; 243:154-162. [PMID: 35344853 PMCID: PMC9189010 DOI: 10.1016/j.schres.2022.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/21/2022]
Abstract
Multidimensional progressive declines in the absence of standard biomarkers for neurodegeneration are observed commonly in the development of schizophrenia, and are accepted as consistent with neurodevelopmental etiological hypotheses to explain the origins of the disorder. Far less accepted is the possibility that neurodegenerative processes are involved as well, or even that key dimensions of function, such as cognition and aspects of biological integrity, such as white matter function, decline in chronic schizophrenia beyond levels associated with normal aging. We propose that recent research germane to these issues warrants a current look at the question of neurodegeneration. We propose the view that a neurodegenerative hypothesis provides a better explanation of some features of chronic schizophrenia, including accelerated aging, than is provided by neurodevelopmental hypotheses. Moreover, we suggest that neurodevelopmental influences in early life, including those that may extend to later life, do not preclude the development of neurodegenerative processes in later life, including some declines in cognitive and biological integrity. We evaluate these views by integrating recent findings in representative domains such as cognition and white and gray matter integrity with results from studies on accelerated aging, together with functional implications of neurodegeneration for our understanding of chronic schizophrenia.
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Affiliation(s)
- William S. Stone
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, Massachusetts,Corresponding Author: William S. Stone, Ph.D., Massachusetts Mental Health Center, 75 Fenwood Road, Boston, Massachusetts, USA,
| | - Michael R. Phillips
- Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai, China,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Lawrence H. Yang
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York,New York University College of Global Public Health, New York, New York
| | - Lawrence S. Kegeles
- Department of Psychiatry, Columbia University, New York, New York,New York State Psychiatric Institute, New York, New York
| | - Ezra S. Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Topor A, Boe TD, Larsen IB. The Lost Social Context of Recovery Psychiatrization of a Social Process. FRONTIERS IN SOCIOLOGY 2022; 7:832201. [PMID: 35463189 PMCID: PMC9022098 DOI: 10.3389/fsoc.2022.832201] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
From being a concept questioning the core of psychiatric knowledge and practice, recovery has been adopted as a guiding vison for mental health policy and practice by different local, national, and international organizations. The aim of this article is to contextualize the different understandings of recovery and its psychiatrization through the emergence of an individualizing and de-contextualized definition which have gained a dominant position. It ends with an attempt to formulate a new definition of recovery which integrates people in their social context. Research results from various follow-up studies showing the possibility of recovery from severe mental distress have stressed the importance of societal, social and relational factors as well of the person's own agency when facing their distress and reactions from their environment. These researches were published in the 1970s and 80s; a period of struggle for liberation from colonialism, of struggle by women and black people for their civil rights, and a time of de-institutionalization of services directed toward the poor, elderly, handicapped, prisoners, and people with mental health problems. Recovery research pointed at the central role of individuals in their recovery journey and it was understood as a personal process in a social context. However, with neo-liberal political agenda, the personal role of individuals and their own responsibility for their well-being was stressed, and contextual understandings and the role of social, material and cultural changes to promote recovery faded away. Thus, during recent decades recovery has been mostly defined as an individualistic journey of changing the persons and their perception of their situation, but not of changing this situation. Contextual aspects are almost absent. The most quoted definition accepts the limits posed by an illness-based model. This kind of definition might be a reason for the wide acceptance of a phenomenon that was initially experienced as a break with the bio-medical paradigm. Recently, this dominant individualized understanding of recovery has been criticized by service users, clinicians and researchers, making possible a redefinition of recovery as a social process in material and cultural contexts.
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Affiliation(s)
- Alain Topor
- Department of Social Work, Stockholm University, Stockholm, Sweden
- Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway
| | - Tore Dag Boe
- Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway
| | - Inger Beate Larsen
- Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway
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Recovery e saúde mental: uma revisão da literatura latinoamericana. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2021. [DOI: 10.33881/2027-1786.rip.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A abordagem Recovery emergiu nos anos 1970 nos Estados Unidos a partir dos movimentos em defesa dos direitos dos usuários dos serviços de saúde mental, ex-pacientes ou sobreviventes da psiquiatria. A partir da década de 2000 recovery vem orientando serviços de saúde mental em diversos países e muitos acreditam que possa contribuir com os processos de reforma do modelo de atenção em saúde mental em todo o mundo. No campo acadêmico, um número de publicações vem analisando as formas diversas de aplicação da abordagem em níveis nacionais e internacional. O objetivo desta revisão integrativa, realizada em 2019, foi analisar como a abordagem recovery vem sendo tratada na literatura científica na América Latina. A análise gerou categorias temáticas desvelando os principais assuntos abordados nestas publicações, entre eles discussões sobre terminologia, conceito de recovery, práticas, políticas e serviços orientados por recovery e possibilidades da incorporação da abordagem no contexto da Reforma Psiquiátrica Brasileira que, apesar dos obstáculos, ainda pode ser considerada como orientadora da Política Nacional de Saúde Mental no Brasil. A revisão aponta que o número de publicações sobre recovery na América Latina é escasso, comparado com o número de publicações nos Estados Unidos, Canadá, Hong Kong, Europa e Oceania, e são oriundas principalmente do Brasil. Percebe-se, ainda, que os autores brasileiros, em geral, entendem que recovery pode representar uma importante contribuição ao avanço da Reforma Psiquiátrica Brasileira e alguns defendem a necessidade de cautela sobre a incorporação da abordagem sem uma devida adaptação ao contexto social, cultural e econômico local. Também foi apontado que recovery tem sido aplicado em outros contextos sociais.
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Recovery e saúde mental: uma revisão da literatura latinoamericana. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2021. [DOI: 10.33881/2027-1786.hrip.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A abordagem Recovery emergiu nos anos 1970 nos Estados Unidos a partir dos movimentos em defesa dos direitos dos usuários dos serviços de saúde mental, ex-pacientes ou sobreviventes da psiquiatria. A partir da década de 2000 recovery vem orientando serviços de saúde mental em diversos países e muitos acreditam que possa contribuir com os processos de reforma do modelo de atenção em saúde mental em todo o mundo. No campo acadêmico, um número de publicações vem analisando as formas diversas de aplicação da abordagem em níveis nacionais e internacional. O objetivo desta revisão integrativa, realizada em 2019, foi analisar como a abordagem recovery vem sendo tratada na literatura científica na América Latina. A análise gerou categorias temáticas desvelando os principais assuntos abordados nestas publicações, entre eles discussões sobre terminologia, conceito de recovery, práticas, políticas e serviços orientados por recovery e possibilidades da incorporação da abordagem no contexto da Reforma Psiquiátrica Brasileira que, apesar dos obstáculos, ainda pode ser considerada como orientadora da Política Nacional de Saúde Mental no Brasil. A revisão aponta que o número de publicações sobre recovery na América Latina é escasso, comparado com o número de publicações nos Estados Unidos, Canadá, Hong Kong, Europa e Oceania, e são oriundas principalmente do Brasil. Percebe-se, ainda, que os autores brasileiros, em geral, entendem que recovery pode representar uma importante contribuição ao avanço da Reforma Psiquiátrica Brasileira e alguns defendem a necessidade de cautela sobre a incorporação da abordagem sem uma devida adaptação ao contexto social, cultural e econômico local. Também foi apontado que recovery tem sido aplicado em outros contextos sociais.
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Yu YH, Luo W, Liu B, Kuang WH, Davidson L, Wan Chan CL, Lu L, Xiang MZ, Ran MS. Poverty transitions in severe mental illness: longitudinal analysis of social drift in China, 1994-2015. Psychol Med 2021; 52:1-9. [PMID: 33618792 DOI: 10.1017/s0033291721000350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although poverty associated with severe mental illness (SMI) has been documented in many studies, little long-term evidence of social drift exists. This study aimed to unravel the poverty transitions among persons with SMI in a fast change community in China. METHODS Two mental health surveys, using the International Classification of Disease (ICD-10), were conducted in the same six townships of Xinjin county, Chengdu, China in 1994 and 2015. A total of 308 persons with SMI identified in 1994 were followed up in 2015. The profiles of poverty transitions were identified and regression modelling methods were applied to determine the predictive factors of poverty transitions. RESULTS The poverty rate of persons with SMI increased from 39.9% to 49.4% in 1994 and 2015. A larger proportion of them had fallen into poverty (27.3%) rather than moved out of it (17.8%). Those persons with SMI who had lost work ability, had physical illness and more severe mental disabilities in 1994, as well as those who had experienced negative changes on these factors were more likely to live in persistent poverty or fall into poverty. Higher education level and medical treatment were major protective factors of falling into poverty. CONCLUSIONS This study shows long-term evidence on the social drift of persons with SMI during the period of rapid social development in China. Further targeted poverty alleviation interventions should be crucial for improving treatment and mental recovery and alleviating poverty related to SMI.
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Affiliation(s)
- Yue-Hui Yu
- School of Public Administration and Policy, Renmin University of China, Beijing100872, China
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, Xinjin, Chengdu611432, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, Hubei434000, China
| | - Wei-Hong Kuang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu610041, China
| | | | - Cecilia Lai Wan Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Lin Lu
- Peking University Sixth Hospital, Institute of Mental Health, Peking University, Beijing100191, China
| | - Meng-Ze Xiang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu610041, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
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Finding Common Ground for Diverging Policies for Persons with Severe Mental Illness. Psychiatr Q 2020; 91:1193-1208. [PMID: 32857286 DOI: 10.1007/s11126-020-09821-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Two diametrically opposed positions predominate discourse for the care and treatment of persons with severe mental illness: anti-deinstitutionalization and anti-institutionalization. Both share the same goal of ensuring best quality of life for those with severe psychiatric disorders, but pathways to achieving this goal are very different and have resulted in much contention. Supporters of each position espouse a different belief system regarding people with psychiatric disorders and their presumed capabilities, placing varying emphasis on maximizing protection of the community versus protection of individual rights, and result in contrasting mental health policies and practice orientations. The authors delineate the history from which these positions evolved, consequent views, and policies and practices that emerged from these differing attitudes. The article culminates in a proposed practice approach that offers a more balanced approach to serving adults with mental illness -navigating risk management by preserving freedom and opportunities of risk while affording mutually satisfactory "risk control."
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Rhodes P, De jager A. Narrative studies of recovery: A critical resource for clinicians. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12021] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paul Rhodes
- Clinical Psychology Unit, University of Sydney, Sydney, New South Wales, Australia,
| | - Adele De jager
- Clinical Psychology Unit, University of Sydney, Sydney, New South Wales, Australia,
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Evaluation on Efficacy of Psychological and Behavioral Intercession and Its Implications on People with Schizophrenia: A Novel Approach. Community Ment Health J 2020; 56:1103-1109. [PMID: 32086674 DOI: 10.1007/s10597-020-00589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/15/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine and evaluate the efficacy of the spectrum of psychological and behavioral intercession as a novel treatment regime to address the necessity of Schizophrenia affected patients. METHOD A sum of 148 individuals with the first episode of Schizophrenia enrolled in the trial. Patients admitted in our medium-sized hospital with symptoms of schizophrenia were scrutinized carefully and selected for the intercession trial. Total selected individuals were bifurcated into two groups based on guidelines prescribed in the intervention model. Control group or standard care group (SCG) was treated with usual medications and nursing measures of psychiatry practices. Experimental Group (EG) was conferred with enriched psychological strategy and behavioral modules to tackle and satisfy their specific needs. Various methods such as positive and negative syndrome scale (PANSS), several disability screening schedule (SDGSS), satisfaction with life scale (SWLS), global assessment scale (GAS) and finally rate of recurrence of disease were evaluated and analyzed. RESULTS Efficacy of psychological and behavioral intercession on psychotic domine is proved to be effective, and a novel strategy and it is significantly reducing positive and negative psychological symptoms in the experimental group was observed attributing to the intercession. Moreover, a drastic attenuation in the rate of recurrence of disease was supporting a long term efficiency of intercession. CONCLUSION Conducting intervention on psychological and behavioral approach has explored novel treatment outcomes, targeted schizophrenia patients effectively.
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Singla N, Avasthi A, Grover S. Recovery and its correlates in patients with schizophrenia. Asian J Psychiatr 2020; 52:102162. [PMID: 32562926 DOI: 10.1016/j.ajp.2020.102162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
Little information is available from India, on psychological recovery in patients with schizophrenia. Accordingly, this study aimed to evaluate the correlates and stages of the psychological recovery of patients with schizophrenia. 100 patients, in clinical remission, were evaluated on Stages of Recovery Instrument (STORI), Functional Social Support Questionnaire, WHO Quality of life-BREF, Ways of Coping Checklist, Internalised Stigma of Mental Illness Scale, Scale to Assess Unawareness of Mental Disorder and Knowledge of mental illness scale. Majority of the patients (N = 50) belonged to the stage-5 (Growth), and this was followed by those in the stage-4 (stage of rebuilding; N = 22) and stage-3 (stage of preparation; N = 16) of recovery. A higher stage of recovery was associated with lower stigma in all the domains except stigma resistance. Higher use of confrontative coping and accepting responsibility was associated with a higher score in the awareness stage of recovery. In terms of insight, higher awareness about the effect of medication was associated with a higher stage of recovery. Higher disability in the domain of self-care was seen in the lower stage of recovery. Better quality of life in the physical health domain was associated with being in a higher stage of recovery. To conclude, findings of the present study suggest that stigma plays a significant role in determining the outcome in the form of personal recovery. These findings suggest that to organize the services to promote personal recovery, clinicians should not only aim at symptom amelioration but also must focus on stigma to promote psychological recovery.
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Affiliation(s)
- Neha Singla
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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21
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Fully recovered schizophrenics compared to chronic patients on premorbid and treatment characteristics. ACTA ACUST UNITED AC 2020. [DOI: 10.1017/s0767399x00003953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SummaryTen fully recovered schizophrenics (Group A) were compared to 10 chronic schizophrenic patients (Group B) on several variables concerning premorbid adjustment, family interaction, hospitalization, and treatment. Patients in Group A were clearly, but not statistically significantly better than patients in Group B on premorbid adjustment. Likewise, a clear tendency toward an earlier onset of the illness in Group B patients was found. There were also differences between the 2 groups on some family interaction variables, firstly with regard to leadership in the farnily and parent capability for empathy and ability to give love and care. The most important differences were found, however, with respect to treatment. Almost all patients in Group A had been in psychotherapy, while this was only the case for 2 patients in Group B. Patients in Group A attached great importance to the psychotherapeutic treatment, and some also to their religious belief and/or the psychological support from their spouse, in explaining why they had been cured from the illness.
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van Os J, Wright P, Murray RM. Follow-up studies of schizophrenia I: Natural history and non-psychopathological predictors of outcome. Eur Psychiatry 2020; 12 Suppl 5:327s-41s. [DOI: 10.1016/s0924-9338(97)83576-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
SummaryTreatment-resistant schizophrenia does not exist as a discrete entity, so separating patients who will fail to respond to traditional antipsychotics from those who will respond is impossible with 100% accuracy. However, several predictors of poor clinical outcome have emerged from recent research and knowledge of the processes that lead to poor outcome has become increasingly important with the advent of atypical antipsychotics that may be used in patients with treatment-resistant illness. Much of the variation in outcome can be understood in terms of differences in sample selection, outcome definition and stringency of the diagnostic criteria used. Failure to appreciate these mechanisms may lead to over- or underestimation of the proportion of patients with poor treatment response in clinical and research settings. The importance of factors that predict poor outcome should be judged in terms of their effect size and the degree to which alternative explanations for the association with outcome have been excluded. Although much current research is being focused on specific biological predictors, baseline demographic and illness-related factors, such as ethnic group, sex, social class, type of onset, age of onset and concurrent misuse of alcohol or drugs, have large effects on outcome. Although duration of untreated psychosis before first contact with services may independently predict poor outcome, confounding by variables that are associated with both pathways to care and clinical outcome has not been excluded.
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Abstract
SummaryStudies on long-term efficacy and safety should be a main concern in the evaluation of novel antipsychotics. The present paper is a review of important issues related to the design and performance of such trials. The variability of the natural course of schizophrenia, the variability in treatment response, and the variability of actions of different neuroleptics need to be considered. Long-term studies need to address maintenance of efficacy, prevention of relapse and recurrence, health economics, quality of life and a large number of safety issues in order to get approval for new drug applications and reimbursement on expensive new medicines. Assessment instruments for efficacy, tolerability and safety, need to be supplemented with rating scales for various aspects of psychopathology (positive, negative, deficit symptoms), social and work functioning, drug induced mental side effects, quality of life and accounts of total treatment costs.
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Kwakernaak S, Swildens WE, van Wel TF, Janssen RTJM. Symptomatic and Functional Remission in Young Adults with a Psychotic Disorder in a Rehabilitation Focused Team. Community Ment Health J 2020; 56:549-558. [PMID: 31820293 PMCID: PMC7056708 DOI: 10.1007/s10597-019-00512-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 11/30/2019] [Indexed: 12/03/2022]
Abstract
The aim of this study is to assess symptomatic remission (SR) and functional remission (FR) in a rehabilitation focused program for young adults with a psychotic disorder in the Netherlands, and to investigate which individual and mental health care factors are associated with SR and/or FR, by using Routine Outcome Monitoring data and data on met needs and unmet needs for care. Data of 287 young adults were collected. Almost 40% achieved or maintained SR, 34% FR, and 26% achieved or maintained both. In addition to sociodemographic factors, living independently, paid employment, higher levels of compliance with treatment, and better fulfillment of unmet needs for care in relation to psychological distress, company and daytime activities were associated with better outcomes on SR and/or FR. Our findings underscore that to successfully improve and sustain remission in young adults with a psychotic disorder, it is needed to conduct specific research into the relationship between SR and FR.
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Affiliation(s)
- Sascha Kwakernaak
- Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Wilma E. Swildens
- Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands
| | - Tom F. van Wel
- Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands
| | - Richard T. J. M. Janssen
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- Department of Health Care Governance, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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Langlois S, Pauselli L, Anderson S, Ashekun O, Ellis S, Graves J, Zern A, Gaffney E, Shim RS, Compton MT. Effects of perceived social status and discrimination on hope and empowerment among individuals with serious mental illnesses. Psychiatry Res 2020; 286:112855. [PMID: 32092596 PMCID: PMC7775621 DOI: 10.1016/j.psychres.2020.112855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
Hope and empowerment are key elements of recovery in the context of serious mental illnesses (SMI). We examined predictors of hope among individuals with SMI and tested a hypothesized path model in which perceived social status and perceived discrimination adversely impact hope, directly and through their impacts on depressive symptoms. Data from 232 individuals with SMI receiving care in public-sector settings were used in both a multiple linear regression (predicting Herth Hope Scale scores), and in path analyses examining both direct and indirect effects of perceived social status (Social Status Ladder) and perceived discrimination (Everyday Discrimination Scale). Depressive symptoms, perceived social status, and perceived discrimination were predictive of hope. Path analyses revealed that perceived social status has a direct effect on hope and empowerment but also impacts hope through its effects on depression. Similarly, perceived everyday discrimination affects hope and empowerment, though this effect is mediated through its effects on depression. Two alternative models and a trimmed hypothesized model did not fit the data or improve fit. These social determinants of mental health should provoke program and policy change to improve mental health and enhance recovery among persons with SMI.
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Affiliation(s)
| | - Luca Pauselli
- Icahn School of Medicine at Mount Sinai, St. Luke's/West Hospital Center, Department of Psychiatry, 1 Gustave L. Levy Place, New York, NY, USA
| | - Simone Anderson
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | | | - Samantha Ellis
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | - JaShala Graves
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | - Adria Zern
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 722 W. 168(th) Street, New York, NY, USA
| | - Ebony Gaffney
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | - Ruth S Shim
- University of California, Davis, Department of Psychiatry and Behavioral Sciences, 2230 Stockton Blvd, Sacramento, CA, USA
| | - Michael T Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 722 W. 168(th) Street, New York, NY, USA.
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Silva MA, Restrepo D. Functional Recovery in Schizophrenia. ACTA ACUST UNITED AC 2019; 48:252-260. [PMID: 31779876 DOI: 10.1016/j.rcp.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/21/2017] [Accepted: 08/04/2017] [Indexed: 11/24/2022]
Abstract
Recovery in schizophrenia is a topic that generates not only major clinical attention but also a significant economic and social impact. Until seventy years ago, these patients remained held in psychiatric institutions or asylums, usually with no hope of reintegrating into the community. A narrative review of relevant literature was conducted in order to answer key questions regarding recovery in schizophrenia. Treatment objectives in schizophrenia have changed substantially: from expecting a modest control of psychotic symptoms to considering functional recovery as a possibility. Available evidence indicates that one in seven patients with schizophrenia will achieve functional recovery, which implies that remission of positive symptoms is not the ultimate goal of treatment but only a basis for better social and cognitive functioning that translates into better quality of life. This view until recently was not believed to be possible for this major mental disorder.
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Should antipsychotic medications for schizophrenia be given for a lifetime? Replication of a naturalistic, long-term, follow-up study of antipsychotic treatment. CNS Spectr 2019; 24:557-563. [PMID: 30777584 DOI: 10.1017/s109285291800144x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Because ethically and practically a randomized control trial of antipsychotics will never be done, we recently conducted and reported a 8- to 50-year, naturalistic follow-up from an academic clinic of patients with chronic schizophrenia on antipsychotic medication. We found that better medication adherence was a statistically significant predictor of better long-term global outcome and life satisfaction. Because there were important limitations on our findings, we now in this communication, using similar methodology, detail outcomes for a very different sample-inner city patients with chronic schizophrenia with a long past history of antipsychotic treatment, who were enrolled in clinical trials for new medications for schizophrenia. METHODS This is a retrospective, naturalistic, longitudinal 6- to 49-years antipsychotic treatment (mean average, 20) follow-up of a consecutive series of patients volunteering for screening for studies with schizophrenia. Lifetime data were collected on (1) their medication adherence, (2) long-term global outcome, and (3) life satisfaction. Outcomes were rated by 2 different clinicians, 1 with information on medication adherence (nonblind rater) and 1 without (blind rater). We used linear regression models adjusted for age, family support, substance use disorder, race, marital status, and number of years in treatment to estimate the association between adherence and each outcome. RESULTS A total of 34 patients were assessed. Medication adherence was positively associated with the blind clinician's rating of global outcome (P value=0.03) and the global assessment of functioning (P value=0.05). In the nonblinded clinician rating, medication adherence was unrelated to global outcome (P value=0.26) and to patients' report of life satisfaction (P value=0.54). CONCLUSION This replication study, like our previous study, is not inconsistent with the recommendation for continuous, long-term treatment for chronic schizophrenia unless medically contraindicated.
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Roosenschoon BJ, Kamperman AM, Deen ML, van Weeghel J, Mulder CL. Determinants of clinical, functional and personal recovery for people with schizophrenia and other severe mental illnesses: A cross-sectional analysis. PLoS One 2019; 14:e0222378. [PMID: 31532805 PMCID: PMC6750648 DOI: 10.1371/journal.pone.0222378] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/29/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To analyze the relationships between insight, medication adherence, addiction, coping and social support-components of Illness Management and Recovery (IMR)-as determinants of clinical, functional and personal recovery in patients with schizophrenia and other severe mental illnesses. Our rationale lay in the interrelations between these concepts suggested in a conceptual framework of IMR. METHODS The cross-sectional design used baseline data of outpatient participants in a randomized clinical trial on IMR (N = 187). We used structural equation modeling (SEM) to describe pathways between degrees of insight, medication adherence, addiction, coping and social support, and degree of clinical, functional and personal recovery. We also explored whether clinical recovery mediated functional and personal recovery. RESULTS Our final model showed that coping was associated with clinical, functional and personal recovery. Direct associations between coping and functional and personal recovery were stronger than indirect associations via clinical recovery. Although SEM also showed a significant but weak direct pathway between social support and functional recovery, there were no significant pathways either between social support and clinical or personal recovery, or between insight, medication adherence, addiction and any type of recovery. CONCLUSIONS Coping may be a determinant of all three types of recovery, and social support a determinant of functional recovery. Clinical recovery appears not to be a prerequisite for functional or personal recovery. While our results also suggest the relevance of improving coping skills and of enhancing social support, they only partially support the conceptual framework of IMR.
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Affiliation(s)
- Bert-Jan Roosenschoon
- ESPRI Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
- Parnassia Psychiatric Institute, The Hague, the Netherlands
- * E-mail:
| | - Astrid M. Kamperman
- ESPRI Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mathijs L. Deen
- Parnassia Psychiatric Institute, The Hague, the Netherlands
- Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Jaap van Weeghel
- Parnassia Psychiatric Institute, The Hague, the Netherlands
- Tilburg University, Department of Social and Behavioral Sciences, TRANZO Scientific Center for Care and Welfare, Tilburg, the Netherlands
| | - Cornelis L. Mulder
- ESPRI Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
- Parnassia Psychiatric Institute, Antes/Bavo Europoort, Rotterdam, the Netherlands
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Echezarraga A, Las Hayas C, López de Arroyabe E, Jones SH. Resilience and Recovery in the Context of Psychological Disorders. JOURNAL OF HUMANISTIC PSYCHOLOGY 2019. [DOI: 10.1177/0022167819851623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Comparison of the long-term treatment outcomes of women and men diagnosed with schizophrenia over a period of 20 years. A prospective study. Compr Psychiatry 2018; 84:62-67. [PMID: 29694934 DOI: 10.1016/j.comppsych.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/02/2018] [Accepted: 03/31/2018] [Indexed: 11/23/2022] Open
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Lahera G, Gálvez JL, Sánchez P, Martínez-Roig M, Pérez-Fuster JV, García-Portilla P, Herrera B, Roca M. Functional recovery in patients with schizophrenia: recommendations from a panel of experts. BMC Psychiatry 2018; 18:176. [PMID: 29871616 PMCID: PMC5989342 DOI: 10.1186/s12888-018-1755-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/22/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The management of schizophrenia is evolving towards a more comprehensive model based on functional recovery. The concept of functional recovery goes beyond clinical remission and encompasses multiple aspects of the patient's life, making it difficult to settle on a definition and to develop reliable assessment criteria. In this consensus process based on a panel of experts in schizophrenia, we aimed to provide useful insights on functional recovery and its involvement in clinical practice and clinical research. METHODS After a literature review of functional recovery in schizophrenia, a scientific committee of 8 members prepared a 75-item questionnaire, including 6 sections: (I) the concept of functional recovery (9 items), (II) assessment of functional recovery (23 items), (III) factors influencing functional recovery (16 items), (IV) psychosocial interventions and functional recovery (8 items), (V) pharmacological treatment and functional recovery (14 items), and (VI) the perspective of patients and their relatives on functional recovery (5 items). The questionnaire was sent to a panel of 53 experts, who rated each item on a 9-point Likert scale. Consensus was achieved in a 2-round Delphi dynamics, using the median (interquartile range) scores to consider consensus in either agreement (scores 7-9) or disagreement (scores 1-3). Items not achieving consensus in the first round were sent back to the experts for a second consideration. RESULTS After the two recursive rounds, consensus was achieved in 64 items (85.3%): 61 items (81.3%) in agreement and 3 (4.0%) in disagreement, all of them from section II (assessment of functional recovery). Items not reaching consensus were related to the concepts of functional recovery (1 item, 1.3%), functional assessment (5 items, 6.7%), factors influencing functional recovery (3 items, 4.0%), and psychosocial interventions (2 items, 5.6%). CONCLUSIONS Despite the lack of a well-defined concept of functional recovery, we identified a trend towards a common archetype of the definition and factors associated with functional recovery, as well as its applicability in clinical practice and clinical research.
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Affiliation(s)
- Guillermo Lahera
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, Plaza de San Diego, s/n, 28801 Alcalá de Henares, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - José L Gálvez
- Unidad de Salud Mental Comunitaria del Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, S/N, 41013, Sevilla, Spain
| | - Pedro Sánchez
- Unidad de Psicosis Refractaria, Hospital Psiquiátrico de Álava-Osakidetza, C/ Álava, n°45, 01006, Vitoria - Gasteiz, Spain
- Facultad de Medicina, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Leioa, Spain
| | | | - J V Pérez-Fuster
- Centro de Salud Mental Fuente San Luis, Hospital Universitario Doctor Peset, Av. de Gaspar Aguilar, 90, 46017, València, Spain
| | - Paz García-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Área de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Av. Julián Clavería, s/n, 33006, Oviedo, Asturias, Spain
| | - Berta Herrera
- Medical Affairs Department, Janssen-Cilag, Avenida Partenón, 16 1 (Campo de las Naciones), S. A, 28042, Madrid, Spain
| | - Miquel Roca
- Institut Universitari d'Investigació en Ciencies de la Salut (IUNIS), RedIAPP, Hospital Juan March, Universidad de las Islas Baleares, Cra. de Valldemossa, km 7.5., Palma de Mallorca, (Illes Balears), Spain.
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Abstract
‘Recovery’ is usually taken as broadly equivalent to ‘getting back to normal’ or ‘cure’, and by these standards few people with severe mental illness recover. At the heart of the growing interest in recovery is a radical redefinition of what recovery means to those with severe mental health problems. Redefinition of recovery as a process of personal discovery, of how to live (and to live well) with enduring symptoms and vulnerabilities opens the possibility of recovery to all. The ‘recovery movement’ argues that this reconceptualisation is personally empowering, raising realistic hope for a better life alongside whatever remains of illness and vulnerability. This paper explores the background and defining features of the international recovery movement, its influence and impact on contemporary psychiatric practice, and steps towards developing recovery-based practice and services.
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Young DKW, Ng PYN, Pan J. Predictors and Prevalence of Recovery and Remission for Consumers Discharged from Mental Hospitals in a Chinese Society. Psychiatr Q 2017; 88:839-851. [PMID: 28229345 DOI: 10.1007/s11126-017-9497-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This research study examines the 1 year rate of recovery and remissions for consumers recently discharging from mental hospitals and identifies factors predicting recovery and remissions in the Hong Kong context. By adopting a prospective longitudinal follow-up research design, a cohort of Chinese people discharged from the mental hospitals and participating in a community-based psychosocial program was followed for 1 year. These individuals were assessed by using standardized assessment scales at baseline, 6 months, and 12 months of follow-up. At 1 year follow up, the rates of recovery, functional and symptomatic remission were 8.0%, 23.0% and 79.3% respectively. Logistic regression analyses indicted that: current recovery was significantly predicted by baseline functioning level and achieving open employment, symptomatic remission was significantly predicted by previous symptom severity and having open employment at baseline, while functional remission was significantly predicted by previous functioning level and having open employment. Result indicates that it is more difficult to achieve functional remission and recovery than symptomatic remission for consumers recently discharging from mental hospitals. Also, symptomatic remission is found not a sufficient condition for recovery, while functional remission plays a vital role in recovery. Helping consumers to achieve open employment and improve social functioning are identified as the predicting factors for recovery and functional remission in the local context.
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Affiliation(s)
- Daniel K W Young
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong. .,AAB1015, Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong.
| | - Petrus Y N Ng
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Jiayan Pan
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
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Immonen J, Jääskeläinen E, Korpela H, Miettunen J. Age at onset and the outcomes of schizophrenia: A systematic review and meta-analysis. Early Interv Psychiatry 2017; 11:453-460. [PMID: 28449199 PMCID: PMC5724698 DOI: 10.1111/eip.12412] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/25/2016] [Indexed: 12/03/2022]
Abstract
The aim of this study was to analyse the effect of age at onset on the long-term clinical, social and global outcomes of schizophrenia through a systematic review and a meta-analysis. Original studies were searched from Web of Science, PsycINFO, Pubmed and Scopus, as well as manually. Naturalistic studies with at least a 2-year follow-up were included. Of the 3509 search results, 81 articles fulfilled the inclusion criteria. The meta-analysis was performed in Stata as a random-effect analysis with correlation coefficients between age at onset and the outcomes (categorized into remission, relapse, hospitalization, positive symptoms, negative symptoms, total symptoms, general clinical outcome, employment, social/occupational functioning and global outcome). There was a statistically significant (P < .05) correlation between younger age at onset and more hospitalizations (number of studies, n = 9; correlation, r = 0.17; 95% confidence interval, CI 0.09-0.25), more negative symptoms (n = 7; r = 0.14; 95% CI 0.01-0.27), more relapses (n = 3; r = 0.11; 95% CI 0.02-0.20), poorer social/occupational functioning (n = 12; r = 0.15; 95% CI 0.05-0.25) and poorer global outcome (n = 13; r = 0.14; 95% CI 0.07-0.22). Other relationships were not significant. This was the first systematic review of the effects of age at onset on the long-term outcomes of schizophrenia. The results show that age at onset has a small, but significant impact on some of the outcomes of schizophrenia.
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Affiliation(s)
- Johanna Immonen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Erika Jääskeläinen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
- Oulu Occupational HealthOuluFinland
| | - Hanna Korpela
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Jouko Miettunen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
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Pachoud B. Activité professionnelle et processus de rétablissement. SANTE MENTALE AU QUEBEC 2017. [DOI: 10.7202/1041914ar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Il est largement reconnu que l’exercice d’une activité professionnelle est un des facteurs contribuant le plus efficacement au rétablissement des personnes vivant avec des troubles mentaux sévères. En nous fondant sur une synthèse de la littérature pertinente dans ce domaine, nous nous attachons dans cet article à montrer que le lien étroit entre travail et rétablissement mérite d’être envisagé non seulement en partant du travail pour souligner ses apports au processus de rétablissement, mais également en partant d’une conception approfondie du rétablissement et de ce qu’il implique, pour contextualiser dans ce cadre les pratiques de soutien à l’emploi. Il est intéressant de remarquer la convergence entre les principes des pratiques axées sur le rétablissement et ceux qui orientent les pratiques de référence en matière de soutien à l’emploi. La spécification d’un changement de posture individuelle dans l’accompagnement pour promouvoir le rétablissement importe pour faire évoluer les pratiques d’accompagnement « vers » puis « dans » l’emploi. Nombre de travaux se sont attachés à identifier les façons par lesquelles le travail contribue au processus de rétablissement. Ces bénéfices du travail s’avèrent nombreux et de natures diverses. Ils ont fait l’objet d’études de synthèse qui identifient les principales dimensions en fonction desquelles nous présentons ces facteurs contribuant au rétablissement.
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Affiliation(s)
- Bernard Pachoud
- Professeur de psychopathologie à l’Université Paris Diderot, chercheur au CRPMS (Centre de Recherche Psychanalyse, Médecine et Société)
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Leonhardt BL, Huling K, Hamm JA, Roe D, Hasson-Ohayon I, McLeod HJ, Lysaker PH. Recovery and serious mental illness: a review of current clinical and research paradigms and future directions. Expert Rev Neurother 2017; 17:1117-1130. [PMID: 28885065 DOI: 10.1080/14737175.2017.1378099] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Recovery from serious mental illness has historically not been considered a likely or even possible outcome. However, a range of evidence suggests the courses of SMI are heterogeneous with recovery being the most likely outcome. One barrier to studying recovery in SMI is that recovery has been operationalized in divergent and seemingly incompatible ways: as an objective outcome versus a subjective process. Areas covered: This paper offers a review of recovery as a subjective process and recovery as an objective outcome; contrasts methodologies utilized by each approach to assess recovery; reports rates and correlates of recovery; and explores the relationship between objective and subjective forms of recovery. Expert commentary: There are two commonalities of approaching recovery as a subjective process and an objective outcome: (i) the need to make meaning out of one's experiences to engage in either type of recovery and (ii) there exist many threats to engaging in meaning making that may impact the likelihood of moving toward recovery. We offer four clinical implications that stem from these two commonalities within a divided approach to the concept of recovery from SMI.
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Affiliation(s)
- Bethany L Leonhardt
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,b Midtown Community Mental Health , Eskenazi Health , Indianapolis , IN , USA
| | - Kelsey Huling
- c School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Jay A Hamm
- b Midtown Community Mental Health , Eskenazi Health , Indianapolis , IN , USA
| | - David Roe
- d Department of Community Mental Health, Faculty of Social Welfare and Health Sciences , University of Haifa , Haifa , Israel
| | | | - Hamish J McLeod
- f Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences , University of Glasgow , Glasgow , UK
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,g Department of Psychiatry , Richard L. Roudebush Veteran Affairs Medical Center , Indianapolis , IN , USA
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Whiteford H, Buckingham B, Harris M, Diminic S, Stockings E, Degenhardt L. Estimating the number of adults with severe and persistent mental illness who have complex, multi-agency needs. Aust N Z J Psychiatry 2017; 51:799-809. [PMID: 28718716 DOI: 10.1177/0004867416683814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A population health approach to mental health service planning requires estimates that align interventions with the needs of people with mental illness. The primary objective was to estimate the number of people in Australia living with severe and persistent mental illness who have complex, multi-agency needs. The secondary objective was to describe the possible service needs of individuals with severe mental illness. METHODS We disaggregated the estimated 12-month prevalence of adults with severe mental illness into needs-based sub-groups, using multiple data sources. Possible service needs of 1825 adults with psychotic disorders and 334 adults with severe past-year affective and/or anxiety disorders were described using data from the 2010 Survey of High Impact Psychosis and 2007 National Survey of Mental Health and Wellbeing, respectively. RESULTS Using best available data, we estimated that 3.3% of adults experience a severe mental illness each year, of whom one-third (1.1% of adults) experience a persistent mental illness that requires ongoing services to address residual disability. Among those with severe and persistent mental illness, one-third of adults (0.4% or 59,000 adults in 2015) have complex needs requiring multi-agency support to maximise their health, housing, social participation and personal functioning. Survey of High Impact Psychosis data indicated that among adults with psychotic disorders, use of accommodation (40%), non-government (30%) services and receipt of income support (85%) services were common, as were possible needs for support with socialising, personal care and employment. National Survey of Mental Health and Wellbeing data indicated that among individuals with severe affective and anxiety disorders, receipt of income support (37%) was common (information on accommodation and non-government support services was not available), as were possible needs for financial management and employment support. CONCLUSION Agreed indicators of complex, multi-agency needs are required to refine these estimates. Closer alignment of information collected about possible service needs across epidemiological surveys is needed.
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Affiliation(s)
- Harvey Whiteford
- 1 School of Public Health, The University of Queensland, Herston, QLD, Australia.,2 Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,3 Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Meredith Harris
- 1 School of Public Health, The University of Queensland, Herston, QLD, Australia.,2 Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Sandra Diminic
- 1 School of Public Health, The University of Queensland, Herston, QLD, Australia.,2 Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Emily Stockings
- 5 National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW, Australia
| | - Louisa Degenhardt
- 3 Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,5 National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW, Australia.,6 Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,7 Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia
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Burti L. Attualità di Goffman: quanto contribuisce alla carriera morale di malato mentale la psichiatria di comunità italiana contemporanea? PSICOTERAPIA E SCIENZE UMANE 2017. [DOI: 10.3280/pu2017-002003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Should Antipsychotic Medications for Schizophrenia Be Given for a Lifetime?: A Naturalistic, Long-Term Follow-Up Study. J Clin Psychopharmacol 2017; 37:125-130. [PMID: 28195931 DOI: 10.1097/jcp.0000000000000680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Schizophrenia remains a major health problem despite antipsychotic medications that, for most patients, can decrease acute symptoms, decrease relapses, and contribute to partial and sometimes strong positive response in patients with chronic symptoms. What has not been clear-because a double-blind, randomized, placebo-controlled trial is not feasible or ethical-is how many years after the initial episode, or onset of antipsychotic treatment, should medication be continued to achieve the best global outcome. We designed a small, clinical study to retrospectively perform a detailed follow-up to examine antipsychotic medication because it relates to both global outcome and life satisfaction. METHODS This is a naturalistic study of 35 patients with chronic schizophrenia examining antipsychotic medication adherence from 8 to 50 years (average, 21 y) after onset of antipsychotic treatment. The sample was derived from all patients treated for many years in 1 physician's academic clinic. Most were treated by community physicians before referral to the academic clinic. Information was gathered on (1) medication adherence, (2) long-term global outcomes (based on both the patient ratings and a blind clinician's assessment [blind to medication data] on both the Global Outcome Scale and the Global Assessment of Functioning Scale), and (3) a patient-rated Satisfaction With Life Scale. Spearman rank order correlations were used to relate medication adherence to global outcomes and life satisfaction, as were linear regression models adjusted for demographic and clinical characteristics. RESULTS A total of 35 patients (mean age, 45 y; mean years of possible medication since onset of treatment, 21 y) were assessed. Medication adherence was a statistically significant predictor of better long-term global outcomes and life satisfaction, both in Spearman rank order correlations and in covariate-adjusted linear regressions (all P values <0.01). Poor medication adherence was associated with poor outcomes, often disastrous, with low life satisfaction. Other variables such as presence of substance use disorders or family support did not explain the difference between those who adhered and those who did not. CONCLUSIONS In this naturalistic study, patients who adhered to antipsychotic medication had better long-term global outcomes than those who had poor adherence. Study limitations include the potential for residual confounding. This sample provides data consistent with the recommendation, in the absence of clinically important unwanted drug effects like tardive dyskinesia or large weight gain, for continuous, long-term antipsychotic treatment for chronic schizophrenia.
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Meidlinger PC, Hope DA. The new transdiagnostic cognitive behavioral treatments: Commentary for clinicians and clinical researchers. J Anxiety Disord 2017; 46:101-109. [PMID: 27856069 DOI: 10.1016/j.janxdis.2016.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 11/15/2022]
Abstract
Recognition of the limitations of the current categorical diagnostic system and increased understanding of commonalities across clinical problems associated with negative emotion, including anxiety and depression, has led to the development of transdiagnostic psychological interventions. This new approach holds promise in shifting our emphasis from diagnostic categories to treating core construct that cut across disorders. This paper identifies some of the similarities and differences across various cognitive-behavioral transdiagnostic protocols and key challenges in assessment and case conceptualization for clinicians wishing to use this approach. Some key needs in the research literature that would be particularly helpful to clinicians are also identified.
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Abstract
OBJECTIVES To translate the Stages of Recovery Instrument (STORI) and evaluate its psychometric properties, demographic, and clinical correlates among patients with schizophrenia. MATERIALS AND METHODS The English version of the scale was translated into Hindi using the World Health Organization methodology. The Hindi version was completed by thirty patients with schizophrenia on two occasions, 4-7 days apart. Another thirty patients completed both Hindi and English version within a gap of 4-7 days. In addition, 100 patients completed the Hindi version of STORI once for studying the demographic and clinical correlates of recovery. RESULTS Hindi version of STORI demonstrated good internal consistency (α = 0.854) for the full scale and also for all the five stages of recovery (α = 0.745 to 0.756) as described in the scale. Split-half reliability of the scale was also good, as reflected by a high Spearman-Brown coefficient (0.781) and Guttmann's split-half coefficient (0.778). All the items of the scale showed high test-retest reliability and cross-language equivalence. Correlation between different stages and correlation between the allocated stage and different stages reflected good concurrent and construct validity of the subscales described as various stages of recovery. In general, demographic and clinical variables did not have any significant correlation with stages of recovery. However, those with lower level of general psychopathology scores showed significant correlation with higher stages of recovery. CONCLUSIONS Hindi version of STORI has good psychometric properties.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Singla
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Cohen O. How do we Recover? An Analysis of Psychiatric Survivor Oral Histories. JOURNAL OF HUMANISTIC PSYCHOLOGY 2016. [DOI: 10.1177/0022167805277107] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article analyzes interview and survey data collected during the course of the MindFreedom International Oral History Project from June 1 through September 1, 2001. The purpose of the MindFreedom Oral History Project was to gather stories of experiences in the mental health system from the psychiatric survivor or ex-patient perspective. Thirty-six people participated in the study, most of who consider themselves “psychiatric survivors.” Qualitative and quantitative analysis reveals four major themes emerging from these histories: trauma, social control, internalized oppression, and recovery. The focus of this article is on the theme of recovery. Participants demonstrated resiliency and a strong ability to “recover.” No “magic bullet” was found to work for all participants’ recovery process; instead, participants used a variety of self-designed strategies to recapture their once broken lives.
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Affiliation(s)
- Oryx Cohen
- Western Massachusetts Training Consortium
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Kennedy C, Carlson D, Üstün TB, Regier DA, Norquist G, Sirovatka P. Mental Health, Disabilities, and Women. JOURNAL OF DISABILITY POLICY STUDIES 2016. [DOI: 10.1177/104420739700800207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ongoing development and reform of health care systems worldwide are directing the attention of policymakers to the significance of mental disorders and ensuing disabilities. While this awareness has encouraged empirical work and scientific literature on disabilities associated with mental disorders, insufficient attention has been paid to issues of gender in the context of mental disorder and disability. This paper draws on four data sets-the 1994-96 Disability Survey; the 1992 National Health Interview Survey (NHIS); Social Security Disability Programs; and the recent international measure of Disability-Adjusted Life Years-to explore relationships among gender, mental disorders, and disability in the United States and to consider the special needs presented by women disabled by mental disorders for service development and service configuration. Generally younger than women disabled by physical disorders, women with mental disorders tend to be in their prime child-bearing years. While in the United States private sector managed care programs increasingly are perceived as the most reasonable way to provide health services in a fiscally responsible way, there appears to exist an implicit notion that managed care is intended exclusively for provision of acute care and preventive services. There is little discussion or exploration of the use of managed care systems for rehabilitation generally, or of the particular rehabilitation needs of young women. The implications for the additional “burden” of disabilities along with the potential risk factor of traditional female roles require serious consideration and enlightened policies. Mental
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Abstract
The focus on recent advances in the neurobiology of schizophrenia has pushed aside the psychological understanding of the person with schizophrenia for several decades. However, a useful functional psychology of schizophrenia (in distinction to a psychological approach to symptoms) remains clinically important for several reasons: it is a core part of the bio-psycho-social formulation; it helps us understand and connect with persons with schizophrenia; and it provides a framework by which to organize our treatment efforts (both psychotherapeutic and particularly biological), which can improve adherence and outcomes. A coherent psychological model (the deficit model) based on object relations theory best explains all the biological, psychological, clinical, and sociocultural factors relevant to the understanding and treatment of persons with schizophrenia. A better understanding of a coherent psychology of persons with schizophrenia and provision of psychotherapies improves both the biological and psychotherapeutic treatment of persons with schizophrenia.
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46
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Fisher DB. People Are More Important Than Pills In Recovery From Mental Disorder. JOURNAL OF HUMANISTIC PSYCHOLOGY 2016. [DOI: 10.1177/0022167802250568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Long-term research has shown that many people diagnosed with schizophrenia fully recover. Helping relationships, including psychotherapy, play a much more important role than medications in recovery. This vital information, which could bring hope to countless millions, is routinely suppressed by the pharmaceutical industry. The industry's control of psychiatric research, publications, and training has insured the dominance of the unfounded assertion that all mental illnesses are due to biological brain disorder. Instead, research conducted at the National Empowerment Center (NEC) has emphasized the importance of hope, self-determination, and assistance from people who believe in you. Recovery is facilitated by helping relationships based on trust, understanding, and safety. NEC has developed a new training program, Personal Assistance in Community Existence (PACE), which is based on these principles. PACE is designed to shift the culture of mental health care from an overreliance on pills. People, not pills, are crucial to recovery.
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Nowak I, Sabariego C, Świtaj P, Anczewska M. Disability and recovery in schizophrenia: a systematic review of cognitive behavioral therapy interventions. BMC Psychiatry 2016; 16:228. [PMID: 27400680 PMCID: PMC4940955 DOI: 10.1186/s12888-016-0912-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 06/07/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Schizophrenia is a disabling disease that impacts all major life areas. There is a growing need for meeting the challenge of disability from a perspective that extends symptomatic reduction. Therefore, this study aimed to systematically review the extent to which traditional and "third wave" cognitive - behavioral (CBT) interventions address the whole scope of disabilities experienced by people with lived experience of schizophrenia using the WHO's International Classification of Functioning, Disability and Health (ICF) as a frame of reference. It also explores if current CBT interventions focus on recovery and what is their impact on disability domains. METHODS Medline and PsycINFO databases were searched for studies published in English between January 2009 and December 2015. Abstracts and full papers were screened against pre-defined selection criteria by two reviewers. Methodological quality of included studies was assessed by two independent raters using the Effective Public Health Practice Project Quality assessment tool for quantitative studies (EPHPP) guidelines. RESULTS A total of 50 studies were included, 35 studies evaluating traditional CBT interventions and 15 evaluating "third wave" approaches. Overall, traditional CBT interventions addressed more disability domains than "third wave" approaches and mostly focused on mental functions reflecting schizophrenia psychopathology. Seven studies met the inclusion criteria of recovery-oriented interventions. The majority of studies evaluating these interventions had however a high risk of bias, therefore evidence on their effectiveness is inconclusive. CONCLUSIONS Traditional CBT interventions address more disability domains than "third wave" therapies, however both approaches focus mostly on mental functions that reflect schizophrenia psychopathology. There are also few interventions that focus on recovery. These results indicate that CBT interventions going beyond symptom reduction are still needed. Recovery-focused CBT interventions seem to be a promising treatment approach as they target disability from a broader perspective including activity and participation domains. Although their effectiveness is inconclusive, they reflect users' views of recovery and trends towards improvement of mood, negative symptoms and functioning are shown.
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Affiliation(s)
- Izabela Nowak
- />First Department of Psychiatry, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
| | - Carla Sabariego
- />Department of Medical Informatics, Biometry and Epidemiology – IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Piotr Świtaj
- />First Department of Psychiatry, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
| | - Marta Anczewska
- />First Department of Psychiatry, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
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Linz S, Hanrahan NP, DeCesaris M, Petros R, Solomon P. Clinical Use of an Autovideography Intervention to Support Recovery in Individuals with Severe Mental Illness. J Psychosoc Nurs Ment Health Serv 2016; 54:33-40. [DOI: 10.3928/02793695-20160420-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/25/2016] [Indexed: 11/20/2022]
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McGorry PD. The achievable dream of a humane psychiatry: A tribute to John S. Strauss. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016. [DOI: 10.1080/15487768.2016.1136174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Burhouse A, Rowland M, Marie Niman H, Abraham D, Collins E, Matthews H, Denney J, Ryland H. Coaching for recovery: a quality improvement project in mental healthcare. BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:u206576.w2641. [PMID: 26734387 PMCID: PMC4693036 DOI: 10.1136/bmjquality.u206576.w2641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/08/2015] [Indexed: 11/28/2022]
Abstract
Approximately one in four adults in the UK will experience a mental health difficulty at some point in their life. This figure is approximately 400 million people worldwide.[1] Depression alone is currently estimated to cost the UK 1.7% of GDP and is one of the largest causes of ill health in the world.[2] For conditions like psychosis, evidence tells us that people have poorer quality of life outcomes, are more likely to die early, become obese, smoke, be unemployed, and have long term physical conditions than average.[3] People's social situation is also likely to be more complex, with housing needs, social isolation, stigma, and poverty.[4] All of these factors can make it hard for a person with a long-term mental health condition, or those supporting them, to hold onto a sense of hope that positive change is possible or that "recovery" towards a life that holds optimum meaning to them is achievable. An innovative "pop up" Recovery College model was co-produced, delivered, and evaluated by a team of people with lived experience of mental health difficulties, known as peer trainers. The Recovery College offered courses containing the best evidence-based knowledge about recovery in mental health, self-care and self-management. Each learning session included theory, personal testament from peer trainers, and volunteers and demonstrations of practical self-care skills and techniques. The courses were open to people experiencing mental health difficulties, their families, friends, and professionals. After the college course finished each student was offered up to three individual coaching sessions to help support putting the lessons learnt from the college into practice. The project aimed to test whether this innovative educational and coaching model could offer hope, knowledge and practical skills in self-management to support resilience and recovery. The project was underpinned by quality improvement methodologies to develop, deliver, and refine the model.
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