Late-life schizophrenia: remission, recovery, resilience

Factors associated with recovery during schizophrenia and related disorders: A review of meta-analysis

BACKGROUND

The spectrum of schizophrenia disorders (SSD) is a severe mental disorder. It is one of the main medical causes of disability that generates high health and social costs.

OBJECTIVE

To analyze the factors associated with clinical recovery (CR) (symptomatic remission-SR and functional recovery-FR) and personal recovery (PR) in people diagnosed with SSD.

METHODS

14 meta-analyses focused on recovery were reviewed following the PRISMA model statements. 95 % of CI was established.

RESULTS

Shorter Duration of Untreated Psychosis (Zr = 0.24, [0.17, 0.30]) and total Duration of Untreated Illness (Zr = 0.34, [0.20, 0.48]) were related to greater SR and general functioning, respectively. Resilience was the variable with the greatest effect on FR (Zr = 0.67, [0.63, 0.71]). Premorbid adjustment (Zr = 0.34, [0.18, 0.49]) and physical intervention (Zr = 0.71, [0.55, 0.86]) had the greatest effect on occupational and social functioning, respectively. Less severe affective symptoms were related to greater PR (Zr = 0.46, [0.42, 0.50]). There are differences between affective SR and the other types of SR (Zr(SR-A - SR-) = 0.13, Qb = 6.51, p = 0.011), (Zr(SR-A - SR+) = 0.20, Qb = 8.52, p = 0.004), (Zr(SR-A - SR) = 0.18, Qb = 19.29, p = 0.0001). In all, resilience was associated with greater recovery (Zr = 0.67, [0.53, 0.80]), with the global effect being greater on PR than on CR (Zr(PR-CR) = 0.07, Qb = 3.45, p = 0.05).

CONCLUSIONS

Resilience was the variable most strongly associated with recovery. Symptomatic or functional improvement obtained less statistical weight.

Correlation of health literacy, health management self-efficacy, and attitude in elderly patients with schizophrenia: A cross-sectional study

AIM

The study investigated the relationship between chronic diseases and health problems, emotional health status, health literacy, health self-management attitude, and health management self-efficacy in older patients with schizophrenia. It is expected to provide multiple health perspectives in the care of older patients with schizophrenia and improve their health literacy and self-management.

DESIGN

A cross-sectional study.

METHODS

Data collection from 2020/09 to 2021/10, the study of older patients with schizophrenia who were diagnosed with schizophrenia and were over 50 years, live in residential mental rehabilitation institutions in eastern Taiwan as older people. Data were collected on demographic variables, chronic diseases, health problems, health literacy, healthy management self-efficacy, and attitudes.

RESULTS

The study results show 61.49 years (SD = 6.57), the gender, health literacy, and health management self-efficacy can effectively explain the variance of health self-management state by 18.5% (F(3,116)  = 10.01, p < 0.000), in which health literacy (β = 0.28, t = 3.07, p = 0.003) and health management self-efficacy (β = 0.19, t = 2.03, p = 0.04) that in the analysis of predictors, emotional health status, and health literacy not only have significant explanatory power on health management self-efficacy and the performance of physical functions but are also important factors affecting the quality of life among the elderly; the important influencing factor of health management self-efficacy and health self-management behaviour is health literacy. Therefore, health literacy is crucial to the health attitudes of older patients with schizophrenia.

CONCLUSION

This study found that increased health literacy among older patients with schizophrenia can enhance their attitude and ability to manage their health. IMPLICATIONS FOR THE PROFESSION AND NO PATIENT OR PUBLIC CONTRIBUTION: Nursing can provide nursing measures related to individual health literacy to help patients improve their health literacy, maintain the health of chronic older patients with schizophrenia, reduce elderly schizophrenia disability, enhance patients' ability to manage their self-efficacy and health self-management attitude, and improving the health and quality of life of patients.

Resilience in Adult Health Science Revisited-A Narrative Review Synthesis of Process-Oriented Approaches

Purpose: This article aims to identify how the term “resilience” is addressed in adult health science due to ongoing criticism about the lack of consistency in its conceptualization.

Method: Two databases (PubMed and PsycArticles) were searched to retrieve reviews published from 2015 up until 2020 on the general conceptualization of resilience. All reviews had to meet specific inclusion criteria, which resulted in the inclusion of 18 articles. After discussing different conceptualizations regarding the process-oriented approach of resilience in adult health research, we will highlight some mechanisms that are supposed to be involved in the resilience process.

Results: Research on resilience in health sciences confronts three core difficulties: defining positive outcome for a processual construct, describing different trajectories within the process, and identifying mechanisms that mediate resilience.

Conclusion: The definition of resilience in mental health research as a multidimensional adaptation process is widely accepted, and multiple research paradigms have contributed to a better understanding of the concept. However, the definition of a processual construct in a way that allows for high expert consensus and a valid operationalization for empirical studies remains a challenge. Future research should focus on the assessment of multiple cross-domain outcomes and international and interdisciplinary prospective mixed-method longitudinal designs to fill in the missing links.

Psychometric Properties of the Brief Resilient Coping Scale in a Sample of Stable Severe Mental Disorder Patients

The aim of this study was to analyze the psychometric properties of the Brief Resilient Coping Scale (BRCS). 57 stable severe mental disorder patients (42 men, 73.7%, and 15 women, 26.3%), ranging in age between 23 and 64 years, (M = 46.25; SD = 7.52) answered to the BRCS and the World Health Organization Quality of Life Assessment (WHOQOL-BREF). Descriptive analyses, estimations of internal consistency, and confirmatory factor analysis were conducted, and correlations between the BRCS and the WHOQOL-BREF were calculated. The factorial validity of the scale was tested using confirmatory factor analysis, with a single dimension of resilience. The BRCS showed acceptable internal consistency (alpha of .69). Correlations between the BRCS and WHOQOL-BREF were positive, r(PhH-R) = .42, r(PsH-R) = .40, r(SR-R) = .33, r(E-R) = .35, and significant (p < .01). In conclusion, the Spanish adaptation of the BRCS seems to be a reliable and valid measure of resilience in stable severe mental disorder patients.

Conceptualizing resilience in adult mental health literature: A systematic review and narrative synthesis

PURPOSE

This review aims to identify how the term 'resilience' is conceptualized across adult mental health research due to ongoing criticism regarding the lack of consistency in its conceptualization.

METHOD

A systematic search, including hand searches of book chapters, was conducted using search terms ('resilien*') AND ('mental illness' OR 'mental health problem'). Papers were excluded if they did not meet the following criteria: written in English, provide a clear conceptualization of resilience, include only adults (aged 18 + ) in the sample, solely focus on individuals with a primary diagnosis of mental illness, and peer-reviewed. Data were extracted on conceptualizations of resilience, demographic, and diagnostic variables of the study population, publication year, and the research design used. Conceptualizations were combined and collapsed into overarching themes and then refined through joint discussion, consultation with a third reviewer, and input from a larger multidisciplinary team.

RESULTS

Thirty-one texts (6 book chapters, 4 reviews, 2 appraisals/critical evaluations, 1 editorial, and 18 research projects) were included. Two broad understandings of resilience were identified: resilience as a process and resilience as a characteristic of an individual. Processes comprise three themes: 'immunity', 'bouncing back', and 'growth', whilst characteristics are captured in two themes 'personal resources' and 'social resources'.

CONCLUSIONS

These findings suggest that resilience can be conceptualized in a clear and meaningful manner in adult mental health research. The five themes reflect distinct ways of using the term resilience. Whilst each one of them may have merit in future research, it appears beneficial to make clear in research which exact conceptualization of resilience has been adopted.

PRACTITIONER POINTS

When considering and reading about 'resilience', one should be aware that there are different concepts of it. The main difference is between resilience as a personal characteristic and resilience as a process. Therapy may address resilience as a personal characteristic by utilizing individual and social resources. The therapeutic process may be understood as resilience in form of bouncing back and personal growth.

Components of schizophrenia liability are not uniformly associated with stress sensitivity, resilience, and coping

Stress sensitization is a candidate final common pathway for the development of schizophrenia. In other psychopathologies, resilience attenuates the stressor-outcome relationships. Therefore, we sought to determine whether resilience moderates the association between stress sensitivity and schizophrenia liability. Undergraduates (n = 230) self-reported cognitive-perceptual, interpersonal, and disorganisation attributes of schizophrenia liability as well as ratings of sensitivity to stress, resilience, and dispositional coping behaviour. Bivariate analyses showed components of schizophrenia liability were significantly predicted by greater stress sensitivity, poor resilience and adaptive coping, and greater maladaptive coping behaviour. However, regression modelling suggested that cognitive-perceptual attributes were uniquely predicted by stress sensitivity in models that include resilience. In contrast, interpersonal attributes had a weaker relationship with stress sensitivity and were strongly predicted by poor resilience. In general, resilience did not moderate the relationship of stress sensitivity with schizophrenia liability. Unexpectedly, some specific attributes of resilience (personal strength, structured style) potentiated the relationship of stress sensitivity with schizophrenia liability. We conclude that the relationships of stress sensitivity, resilience, and coping with attributes of schizophrenia liability are not uniform and speculate that the pattern of associations may reflect the different influences of chronic stress exposures and neurocognitive functioning.

Very Late-Onset Schizophrenia-Like Psychosis: A Clinical Update

Psychosis symptoms (delusions and hallucinations) are multifactorial in origin and, in later life, occur in the context of schizophrenia, delirium, dementia, delusional and schizophrenia-like disorders, mood disorders, and alcohol or substance abuse. The current article provides a clinical overview of very late-onset (after age 60) schizophrenia-like psychosis (VLOSLP), summarizing the literature on treatment options and reflecting on the role of psychiatric-mental health nurses (PMHNs). Increased awareness of the clinical presentation, key features, and evidence-based treatment options will assist PMHNs to confidently recognize this often under-diagnosed disorder and adopt a more assertive role in terms of engagement and follow up. Pragmatic research involving individuals with VLOSLP is required to increase the evidence base for treatment and improve outcomes of care. [Journal of Psychosocial Nursing and Mental Health Services, 56(1), 37-47.].