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van der Heijden-Hobus IMW, Rosema BS, Vorstman JAS, Kas MJH, Franke SK, Boonstra N, Sommer IEC. Personal preferences for treatment and care during and after a First Episode Psychosis: A qualitative study. Early Interv Psychiatry 2023. [PMID: 38030570 DOI: 10.1111/eip.13477] [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: 01/13/2023] [Revised: 08/31/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
AIM A first episode of psychosis (FEP) is a stressful, often life-changing experience. Scarce information is available about personal preferences regarding their care needs during and after a FEP. Whereas a more thorough understanding of these preferences is essential to aid shared decision-making during treatment and improve treatment satisfaction. METHODS Face-to-face interviews with participants in remission of a FEP were set up, addressing personal preferences and needs for care during and after a FEP. The interviews were conducted by a female and a male researcher, the latter being an expert with lived experience. RESULTS Twenty individuals in remission of a FEP were interviewed, of which 16 had been hospitalized. The distinguished themes based on personal preferences were tranquillity, peace and quietness, information, being understood, support from significant others, and practical guidance in rebuilding one's life. Our findings revealed that the need for information and the need to be heard were often not sufficiently met. For 16/20 participants, the tranquillity of inpatient treatment of the FEP was predominantly perceived as a welcome safe haven. The presence and support of family and close friends were mentioned as an important factor in the process of achieving remission. CONCLUSIONS The current exploratory study showed that patients were able to indicate their personal needs. Important findings are the need for information and the need to be heard. Interestingly, hospitalization was mostly seen as an opportunity to achieve tranquillity. More lived experience expertise is needed to elucidate the needs of individuals in the early phase of a FEP to aid people who are recovering from their first psychosis in rebuilding their lives again.
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Affiliation(s)
- Inge M W van der Heijden-Hobus
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Janssen-Cilag B.V., Breda, The Netherlands
| | - Bram-Sieben Rosema
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacob A S Vorstman
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
- SickKids Research Institute & Genetics & Genome Biology Program, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Martien J H Kas
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - Sigrid K Franke
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nynke Boonstra
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- NHL/Stenden, University of Applied Sciences, Leeuwarden, The Netherlands
- KieN VIP Mental Health Care Services, Leeuwarden, The Netherlands
| | - Iris E C Sommer
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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2
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Mlay JP, Jamieson L, Ntlantsana V, Naidu T, Bhengu BS, Paruk S, Burns JK, Chiliza B, Lessells R, Tomita A. Developing and testing unconditional cash transfer strategies among young adults with first-episode psychosis in South Africa: a study protocol for a pilot randomised control trial (PRS-FEP trial). BMJ Open 2022; 12:e067026. [PMID: 36576187 PMCID: PMC9723892 DOI: 10.1136/bmjopen-2022-067026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Access to mental health services is a challenge, especially for young people who are over-represented in the unemployment and poverty index in South Africa. Therefore, continuing care is a problem after hospital discharge for young people with first-episode psychosis (FEP) due to a lack of clinical engagement and follow-up, for which they need support, including financial, to improve their outcomes. This pilot randomised control trial (RCT) aims to assess the feasibility and acceptability of financial support, in the form of an unconditional cash transfer (UCT), among young patients with FEP to prevent relapse. METHODS AND ANALYSIS This study will use a 1:1 ratio two-arm open-label pilot RCT of 60 young participants (18-29 years) with FEP in remission, who will be recruited from specialised psychiatric facilities in KwaZulu-Natal Province, South Africa. This study will implement an UCT and assess its feasibility, acceptability and preliminary clinical outcomes (ie, medication adherence, relapse, quality of life, personal and social function). The follow-up time will be 3 months, the outcomes being measured at baseline, months 1 and 3. Descriptive and conventional content analysis will be done for quantitative and qualitative data, respectively. ETHICS AND DISSEMINATION The study obtained provisional approval from the Biomedical Research Ethics Committee at the University of KwaZulu-Natal(#BREC/00004117/2022). Also is registered on the South African National clinical trial registry (#DOH-27-092022-5894) and approved by the KwaZulu-Natal department of health (#NHRD Ref: KZ_2002209_033). The results from this investigation will be actively disseminated through peer-reviewed journal publications, conference presentations and stakeholder engagement. TRIAL REGISTRATION NUMBER DOH-27-092022-5894.
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Affiliation(s)
- Joyce Protas Mlay
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - Vuyokazi Ntlantsana
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Thirusha Naidu
- Discipline of Behavioural Medicine, University of KwaZulu-Natal School of Nursing and Public Health, Durban, KwaZulu-Natal, South Africa
| | - Busisiwe Siphumelele Bhengu
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Saeeda Paruk
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Jonathan K Burns
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Bonginkosi Chiliza
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Richard Lessells
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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3
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AshaRani PV, Tan YWB, Samari E, Wang P, Cetty L, Satghare P, Ho J, Koh SA, Zhong Yi L, Tang C, Verma S, Subramaniam M. Needs of patients with early psychosis: A comparison of patient's and mental health care provider's perception. Front Psychiatry 2022; 13:952666. [PMID: 36203834 PMCID: PMC9531114 DOI: 10.3389/fpsyt.2022.952666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/26/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Needs define the capacity of a patient to benefit from health care services and a systematic assessment of needs allows planning and delivery of effective treatment to suit patients. This study aimed to understand the (a) needs felt by patients and those perceived by the care providers (CPs), (b) agreement between patients and CPs in the identified needs and (c) factors associated with unmet needs. METHODS Participants (N = 215) were recruited through convenience sampling from the Early Psychosis Intervention Programme (EPIP). Data was captured from patients and CPs using the Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS). RESULTS Patients and CPs identified an average of 4.06 and 3.84 needs, respectively. The highest number of unmet needs were identified for the social (50% of patients and CPs) and health domains (31.13% of patients' vs. 28.30% of CPs). Company, intimate relationships, psychotic symptoms, money, sexual expression and psychological distress, information and benefits were the unmet needs identified by patients, whereas company, intimate relationships, physical health, and daytime activities were identified by CPs. The concordance between patients and CPs was low with majority of the items scoring slight to fair agreement (Cohen's kappa = 0-0.4). Older age, depression, severe anxiety and having Obsessive-Compulsive Disorder (OCD) were positively associated with unmet needs in patients. CONCLUSION While there was an overall consensus on the total needs and met needs between patients and CPs, the level of agreement between the two groups on various items were low. Different perceptions regarding unmet needs were noted between the groups. A holistic approach that takes into account different facets of the needs of patients together with strategic planning to address unmet needs might improve treatment outcomes and satisfaction.
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Affiliation(s)
- P V AshaRani
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Pratika Satghare
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jayne Ho
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Shiyun Astelle Koh
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Lee Zhong Yi
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Charmaine Tang
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Swapna Verma
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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4
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Lavi-Rotenberg A, Roe D, Asher M, Hasson-Ohayon I. A Qualitative Evaluation of the Effects of Social Cognition and Interaction Training (SCIT) Versus Therapeutic Alliance Focused Therapy (TAFT) Among Persons With Serious Mental Illness. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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5
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Davies EL, Gordon AL, Hooper KJ, Pelentsov LJ, Esterman AJ. Evaluating the Reliability of the Needs in Recovery Assessment (NiRA) with Simulated Patients. Issues Ment Health Nurs 2021; 42:845-854. [PMID: 33759706 DOI: 10.1080/01612840.2021.1894618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Needs in Recovery Assessment (NiRA) is a tool designed to support recovery-oriented and person-centred approaches in mental health services through facilitating the identification and prioritisation of needs. The aim of this study was to evaluate the interrater reliability of the NiRA. Method: Ten mental health clinicians from various professional backgrounds used the NiRA to facilitate assessment interviews with Simulated Patients. Completed and semi-completed NiRA forms, questionnaires, and audio-visual recordings of assessment interviews were collected for analysis. The interrater reliability of the NiRA was calculated using percent agreement and Gwet's Agreement Coefficient (AC)1. Results: Percent agreement across all items of the finalised tool was 0.84 (item range: 0.55 to 1.0). Overall interrater reliability (Gwet's AC1) was 0.70 (95% CI 0.64-0.76) with items ranging from -0.08 to 1.0. Conclusion: The NiRA is a reliable tool and is ready to be trialled in a feasibility study in clinical settings. It is anticipated that the NiRA will facilitate a deeper understanding of service users' needs and a more targeted approach to meeting unmet needs.
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Affiliation(s)
- Ellen L Davies
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia.,Clinical and Health Services, University of South Australia, Adelaide, South Australia
| | - Andrea L Gordon
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia
| | - Kenneth J Hooper
- Youth Mental Health Service, Southern Adelaide Local Health Network, Oaklands Park, South Australia
| | - Lemuel J Pelentsov
- Clinical and Health Services, University of South Australia, Adelaide, South Australia
| | - Adrian J Esterman
- Clinical and Health Services, University of South Australia, Adelaide, South Australia
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6
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de Nijs J, Burger TJ, Janssen RJ, Kia SM, van Opstal DPJ, de Koning MB, de Haan L, Cahn W, Schnack HG. Individualized prediction of three- and six-year outcomes of psychosis in a longitudinal multicenter study: a machine learning approach. NPJ SCHIZOPHRENIA 2021; 7:34. [PMID: 34215752 PMCID: PMC8253813 DOI: 10.1038/s41537-021-00162-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/17/2021] [Indexed: 02/06/2023]
Abstract
Schizophrenia and related disorders have heterogeneous outcomes. Individualized prediction of long-term outcomes may be helpful in improving treatment decisions. Utilizing extensive baseline data of 523 patients with a psychotic disorder and variable illness duration, we predicted symptomatic and global outcomes at 3-year and 6-year follow-ups. We classified outcomes as (1) symptomatic: in remission or not in remission, and (2) global outcome, using the Global Assessment of Functioning (GAF) scale, divided into good (GAF ≥ 65) and poor (GAF < 65). Aiming for a robust and interpretable prediction model, we employed a linear support vector machine and recursive feature elimination within a nested cross-validation design to obtain a lean set of predictors. Generalization to out-of-study samples was estimated using leave-one-site-out cross-validation. Prediction accuracies were above chance and ranged from 62.2% to 64.7% (symptomatic outcome), and 63.5-67.6% (global outcome). Leave-one-site-out cross-validation demonstrated the robustness of our models, with a minor drop in predictive accuracies of 2.3% on average. Important predictors included GAF scores, psychotic symptoms, quality of life, antipsychotics use, psychosocial needs, and depressive symptoms. These robust, albeit modestly accurate, long-term prognostic predictions based on lean predictor sets indicate the potential of machine learning models complementing clinical judgment and decision-making. Future model development may benefit from studies scoping patient's and clinicians' needs in prognostication.
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Affiliation(s)
- Jessica de Nijs
- grid.5477.10000000120346234Department of Psychiatry, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Thijs J. Burger
- grid.491093.60000 0004 0378 2028Arkin, Institute for Mental Health, Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronald J. Janssen
- grid.5477.10000000120346234Department of Psychiatry, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Seyed Mostafa Kia
- grid.5477.10000000120346234Department of Psychiatry, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Daniël P. J. van Opstal
- grid.5477.10000000120346234Department of Psychiatry, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Mariken B. de Koning
- grid.491093.60000 0004 0378 2028Arkin, Institute for Mental Health, Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- grid.491093.60000 0004 0378 2028Arkin, Institute for Mental Health, Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Wiepke Cahn
- grid.5477.10000000120346234Department of Psychiatry, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands ,grid.413664.2Altrecht, General Mental Health Care, Utrecht, The Netherlands
| | - Hugo G. Schnack
- grid.5477.10000000120346234Department of Psychiatry, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
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7
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Davies EL, Hooper KJ, Pelentsov LJ, Gordon AL, Esterman AJ. Development and validation of the Needs in Recovery Assessment (NiRA): A clinical tool for assessing the needs of individuals recovering from a first episode of mental illness. Int J Ment Health Nurs 2020; 29:639-651. [PMID: 32048399 DOI: 10.1111/inm.12697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 11/29/2022]
Abstract
Recovering from a first episode of mental illness entails unique challenges and often includes experiencing unmet needs. The availability of a formal, structured and valid means of assessing the needs of individuals recovering from a first episode of mental illness may improve mental health service delivery. This article describes the development of a new needs assessment tool, the Needs in Recovery Assessment (NiRA), and presents the results of processes used to validate the tool. The NiRA was developed using data collected in a previous literature review and focus groups with mental health service users. It contains three sections for the identification, prioritization, planning and re-evaluation of a broad array of needs. It was presented in two workshops, where mental health service users and clinicians evaluated its validity, acceptability and usability. Items of need and the format of the NiRA were evaluated using Likert-scale questions, open-ended short answer and closed questions. Each item of need was evaluated for its validity by a panel of experts via an online survey. Descriptive statistics were used to analyse data, including means, percentages and the Content Validity Index (CVI).Streiner and Kottner's scale development and testing guidelines were used in the reporting of this study. 48 items of need were evaluated as valid by mental health service users, clinicians and academics. Most items received an I-CVI of greater than .93. The scale CVI/Avg was .96. The NiRA is perceived as a valid and acceptable tool for assessing the needs of people recovering from a first episode of mental illness.
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Affiliation(s)
- Ellen L Davies
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Kenneth J Hooper
- Youth Mental Health Service, Southern Adelaide Local Health Network, Oaklands Park, South Australia, Australia
| | - Lemuel J Pelentsov
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Andrea L Gordon
- Australian Center for Child Protection, University of South Australia, Adelaide, South Australia, Australia
| | - Adrian J Esterman
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
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8
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Ismayilova J, Xavier M, Munir KM. Needs Assessment Framework for Mental Health Policy in Treating Persons With Serious Mental Illness in Azerbaijan. Psychiatr Serv 2019; 70:432-435. [PMID: 30630400 PMCID: PMC6494679 DOI: 10.1176/appi.ps.201700474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Persons with serious mental illness and their families in low- and middle-income households continue to face important challenges and barriers to care. In Azerbaijan, the needs of individuals with serious mental illness have been studied to gain insight for improvement of mental health policy and research. This column describes needs assessment work by the National Mental Health Center, located in Baku, as well as lessons learned and further recommendations regarding better targeted, culturally informed, and person-centered care. In particular, the authors emphasize the importance of gender and socioeconomic disparities in care provision, disparities that have a significant parallel in other post-Soviet Eastern European and Central Asian countries.
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Affiliation(s)
- Jamila Ismayilova
- National Mental Health Center, Baku, Azerbaijan (Ismayilova); NOVA University of Lisbon, Lisbon (Xavier); Boston Children's Hospital and Harvard Medical School, Boston (Munir). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Miguel Xavier
- National Mental Health Center, Baku, Azerbaijan (Ismayilova); NOVA University of Lisbon, Lisbon (Xavier); Boston Children's Hospital and Harvard Medical School, Boston (Munir). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Kerim M Munir
- National Mental Health Center, Baku, Azerbaijan (Ismayilova); NOVA University of Lisbon, Lisbon (Xavier); Boston Children's Hospital and Harvard Medical School, Boston (Munir). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
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9
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Liu J, Abdin E, Verma S, Sim K, Chong SA, Subramaniam M. Clarifying pathways to poor psychological health: The mediating role of psychosocial factors in the relationship between general psychopathology and quality of life impairment in patients diagnosed with schizophrenia. J Clin Psychol 2019; 75:1022-1033. [PMID: 30671966 PMCID: PMC6563093 DOI: 10.1002/jclp.22747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives The present study examines the latent factor structure of general psychopathology and investigates the mediating role of unmet psychosocial concerns, motivation, and medication side effects in the relationship between general psychopathology and quality of life (QOL) impairment in patients with schizophrenia. Methods A total of 251 patients completed self‐report measures of unmet psychosocial concerns, motivation, medication side effects, and physical/mental QOL impairment. The severity of schizophrenia was assessed on the Positive and Negative Syndrome Scale. Results Exploratory factor analysis revealed one latent factor (emotional distress) of general psychopathology. Mediation path analyses controlling for confounding variables revealed significant indirect effects of unmet psychosocial concerns, motivation, and medication side effects on emotional distress and physical/mental QOL impairment. Conclusions Our findings suggest that identifying optimal methods of managing co‐occurring emotional distress as well as secondary psychosocial factors on psychological health may improve QOL among patients diagnosed with schizophrenia.
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Affiliation(s)
- Jianlin Liu
- Research DivisionInstitute of Mental HealthSingaporeSingapore
| | | | - Swapna Verma
- Department of Early Psychosis InterventionInstitute of Mental HealthSingaporeSingapore
| | - Kang Sim
- Research DivisionInstitute of Mental HealthSingaporeSingapore
- Department of General PsychiatryInstitute of Mental HealthSingaporeSingapore
| | - Siow Ann Chong
- Research DivisionInstitute of Mental HealthSingaporeSingapore
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10
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Davies EL, Gordon AL, Pelentsov LJ, Hooper KJ, Esterman AJ. Needs of individuals recovering from a first episode of mental illness: A scoping review. Int J Ment Health Nurs 2018; 27:1326-1343. [PMID: 29975442 DOI: 10.1111/inm.12518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2018] [Indexed: 01/29/2023]
Abstract
Central to the role of mental health clinicians is the assessment of needs. A number of assessment tools have been used to evaluate the needs of individuals diagnosed with a mental illness. These tools have largely been developed for people with a severe and persistent mental illness and may not be suitable for individuals who are recovering from a first episode of mental illness. The aims of this review were therefore to identify the needs experienced by individuals recovering from a first episode of mental illness; determine what tools have been used to evaluate these needs; and explore whether existing tools adequately reflect the needs described in the literature. Twenty-one articles were included, comprising articles which identified needs (n = 10), needs assessment tools (n = 1), or articles which identified both needs and a needs assessment tool (n = 10). Results indicate that individuals who have been admitted to a specialized mental health unit and are recovering from a first episode of mental illness may experience an extensive range of needs, spanning emotional, psychological, social, informational, functional, practical, and relationship needs. Four established needs assessment tools were found to have been used to evaluate these needs; however, these do not appear to represent all needs discovered in this review, were mostly developed for populations with a long-term mental illness, and may not be suitable for assessing the needs of individuals recovering from a first episode of mental illness following a presentation to a specialized mental health unit.
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Affiliation(s)
- Ellen L Davies
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Andrea L Gordon
- School of Pharmacy and Biosciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lemuel J Pelentsov
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Kenneth J Hooper
- Youth Mental Health Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Adrian J Esterman
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.,The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
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11
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Affiliation(s)
- Mesut Cetin
- Klinik Psikofarmakoloji Bulteni-Bulletin of Clinical Pychopharmacology, Istanbul-Turkey
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12
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Hensel JM, Banayan DJ, Cheng C, Langley J, Dewa CS. Client and key worker ratings of need in first-episode psychosis early intervention programmes. Early Interv Psychiatry 2016; 10:246-51. [PMID: 25112944 DOI: 10.1111/eip.12171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to fill a gap in the literature by examining agreement on need as rated by clients and their key workers from first-episode psychosis early intervention programmes. Compared with adult populations and more chronic courses of illness, these clients may have unique needs given the onset of their illness in adolescence or early adulthood. METHODS Needs agreement between clients and key workers was assessed using the Camberwell Assessment of Need in a sample of 188 client-key worker pairs recruited from six early intervention programmes in Ontario, Canada. Ratings were assessed with percentage agreement and prevalence-adjusted Cohen's kappa. RESULTS At the aggregate level, both clients and key workers rated a mean of 2.6 unmet needs. Compared with other diagnoses, key workers rated significantly more unmet need in clients with primary psychotic disorders. Agreement between individual client and key worker ratings was highest (adjusted κ > 0.85) in the domains of telephone, risk to others, child care and accommodation. Lowest agreement (adjusted κ < 0.4) was found in the domains of psychological distress, sexual expression, company, daytime activities and intimate relationships. CONCLUSIONS While congruence is present in concrete domains, there is substantial variability in how clients and their key workers perceive need in more personal areas. The initial focus of care may necessarily be on needs such as shelter, food and treatment; however, subsequent care should incorporate a shared assessment of need to support strong relationships with providers and ongoing engagement in treatment.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - David J Banayan
- Department of Psychiatry and Behavioural Neuroscience, University of Chicago, Chicago, Illinois, USA
| | | | - John Langley
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, St.Michael's Hospital, Toronto, Canada
| | - Carolyn S Dewa
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, Canada
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13
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Andrade MCR, Slade M, Bandeira M, Evans-Lacko S, Komaroff J, Martin D, Mari JDJ, Andreoli SB. Subjective distress in a representative sample of outpatients with psychotic disorders. J Affect Disord 2016; 189:220-3. [PMID: 26451507 DOI: 10.1016/j.jad.2015.08.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The affective burden of psychotic disorder has been increasingly recognised. However, subjective reports of distress and its covariates, especially those related to service use, remain under-investigated in patients with psychosis. METHODS This study investigated subjective distress and its covariates in a representative sample of 401 outpatients with a confirmed diagnosis of psychotic disorders in Brazil. Distress was assessed using the corresponding domain of a standardised measure of need - the Camberwell Assessment of Need. RESULTS Distress was reported as a need by 165 (41%) patients, being met in 78 (20%) and unmet in 87 (22%). Hierarchical logistic regression showed that the presence of distress as a need was predicted by attendance at psychotherapy (OR=3.49, CI=1.62-7.53), presence of suicidal ideation (OR=2.89, CI=1.75-4.79), non-attendance at psychosocial rehabilitation (OR=2.84, CI=1.31-6.19), and higher psychopathology (OR=1.09, CI=1.06-1.12). An unmet need was predicted by family not accompanying patients to treatment (OR=2.60, CI=1.05-6.44) and higher psychopathology (OR=1.05, CI=1.02-1.09). LIMITATION The use of a cross-sectional design and a single questionnaire domain to evaluate distress are the main limitations. CONCLUSIONS Subjective distress is a common unmet need in psychosis, and can be treated. The main clinical implication is that subjective distress in psychosis may be impacted on by family engagement and psychosocial interventions.
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Affiliation(s)
- Mário César Rezende Andrade
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Borges Lagoa, 570, Vila Clementino, São Paulo 04038-020, Brazil; King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Mike Slade
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Marina Bandeira
- Department of Psychology, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, Brazil
| | - Sara Evans-Lacko
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK; London School of Economics and Political Science, London, UK
| | - Janina Komaroff
- Centre de Recherche de Montréal sur les Inégalités Sociales et les Discriminations (CREMIS), Montréal, Quebec, Canada
| | - Denise Martin
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Borges Lagoa, 570, Vila Clementino, São Paulo 04038-020, Brazil; Universidade Católica de Santos, Santos, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Borges Lagoa, 570, Vila Clementino, São Paulo 04038-020, Brazil; King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Sérgio Baxter Andreoli
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Borges Lagoa, 570, Vila Clementino, São Paulo 04038-020, Brazil; Universidade Católica de Santos, Santos, Brazil
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Chang WC, Cheung R, Hui CLM, Lin J, Chan SKW, Lee EHM, Chen EYH. Rate and risk factors of depressive symptoms in Chinese patients presenting with first-episode non-affective psychosis in Hong Kong. Schizophr Res 2015; 168:99-105. [PMID: 26235752 DOI: 10.1016/j.schres.2015.07.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depressive symptoms are a distinct symptom dimension in psychotic disorders and are associated with elevated suicide risk, and poorer clinical and functional outcomes. Previous research on depressive symptoms mainly focused on chronic patients and few studies were conducted to investigate factors associated with depression in the early illness course. We aimed to examine the prevalence and risk factors of depressive symptoms, and their impacts on functioning, subjective quality of life (QoL) and self-efficacy in first-episode non-affective psychosis. METHOD Three hundred fifty-one Hong Kong Chinese aged 26-55years presenting with first-episode non-affective psychosis to early intervention service were recruited. Assessments encompassing sociodemographics, premorbid adjustment, clinical and treatment profiles, functioning, QoL and perceived self-efficacy were conducted. Patients who had Calgary Depression Scale for Schizophrenia (CDSS) total score ≥6 were classified as having depressive symptoms. RESULTS Fifty-three (15.1%) patients exhibited depressive symptoms at entry. Depressed patients had worse functioning, poorer QoL and lower level of self-efficacy than non-depressed counterparts. Multivariate regression analysis showed that previous exposure to stressful life events, unemployment, being married, more severe positive symptoms, higher level of antipsychotic-induced Parkinsonism and negative attitude towards medication treatment were independently associated with depression status. CONCLUSIONS Depressive symptoms were frequently observed in adult patients with first-episode nonaffective psychosis, and were linked to poor functioning and QoL. Our findings indicated that, aside from social and clinical risk factors, presence of drug-induced Parkinsonism and negative treatment attitude may render patients more vulnerable to developing depression in the early stage of psychotic illness.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
| | - Rowan Cheung
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Jingxia Lin
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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15
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Oexle N, Ajdacic-Gross V, Müller M, Rodgers S, Rössler W, Rüsch N. Predicting perceived need for mental health care in a community sample: an application of the self-regulatory model. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1593-600. [PMID: 26084865 DOI: 10.1007/s00127-015-1085-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/10/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Most people with mental health problems do not use mental health services, resulting in poor psychiatric outcomes and greater illness burden. Although perceiving the need for mental health care was identified to be a key factor for service use, factors that explain differences in perceived need for mental health care are incompletely understood. The present paper investigates the role of illness representations in predicting perceived need for mental health care. METHODS In a community sample of 202 persons currently distressed by symptoms related to mental illness, illness representations were assessed using the Brief Illness Perception Questionnaire and perceived need for mental health care was measured by the Self-Appraisal of Illness Questionnaire. Multiple linear regression models were used to determine the association between a person's illness representations and the level of perceived need for mental health care. RESULTS Two illness representations were positively associated with perceived need for mental health care: the belief that treatment could improve the current mental health problem and the attribution of experienced symptoms to a mental health problem. Increased perceived need for care was related to current mental health service use. CONCLUSIONS Interventions that aim to increase mental health service use could focus on people's attitudes toward mental health treatment and enable people to recognize symptoms as a mental illness.
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Affiliation(s)
- Nathalie Oexle
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstrasse 11, 89073, Ulm, Germany.
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland.,Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Nicolas Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstrasse 11, 89073, Ulm, Germany
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Karow A, Wittmann L, Schöttle D, Schäfer I, Lambert M. The assessment of quality of life in clinical practice in patients with schizophrenia. DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25152657 PMCID: PMC4140512 DOI: 10.31887/dcns.2014.16.2/akarow] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present article is to review QoL scales used in studies investigating patients with schizophrenia over the past 5 years, and to summarize the results of QoL assessment in clinical practice in these patients. Literature available from January 2009 to December 2013 was identified in a PubMed search using the key words "quality of life" and "schizophrenia" and in a cross-reference search for articles that were particularly relevant. A total of n=432 studies used 35 different standardized generic and specific QoL scales in patients with schizophrenia. Affective symptoms were major obstacles for QoL improvement in patients with schizophrenia. Though positive symptoms, negative symptoms, and cognitive functioning may be seen as largely independent parameters from subjective QoL, especially in cross-sectional trials, long-term studies confirmed a critical impact of early QoL improvement on long-term symptomatic and functional remission, as well as of early symptomatic response on long-term QoL. Results of the present review suggest that QoL is a valid and useful outcome criterion in patients with schizophrenia. As such, it should be consistently applied in clinical trials. Understanding the relationship between symptoms and functioning with QoL is important because interventions that focus on symptoms of psychosis or functioning alone may fail to improve subjective QoL to the same level. However, the lack of consensus on QoL scales hampers research on its predictive validity. Future research needs to find a consensus on the concept and measures of QoL and to test whether QoL predicts better outcomes with respect to remission and recovery under consideration of different treatment approaches in patients with schizophrenia.
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Affiliation(s)
- Anne Karow
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linus Wittmann
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Upthegrove R, Ross K, Brunet K, McCollum R, Jones L. Depression in first episode psychosis: the role of subordination and shame. Psychiatry Res 2014; 217:177-84. [PMID: 24726817 DOI: 10.1016/j.psychres.2014.03.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/11/2014] [Accepted: 03/21/2014] [Indexed: 12/22/2022]
Abstract
Depression in early psychosis is linked to poor outcome, relapse and risk of suicide, yet remains poorly understood. This article aims to examine the development of depression in acute and post psychotic phases of first episode psychosis (FEP), and its relationship to persecutors, voices, insight, and recovery. Data were gathered on 92 patients with acute FEP on depression course, severity and experience of positive symptoms, insight and appraisals of illness using validated semi-structured interviews and questionnaires. Measures were repeated at 12 months. Malevolent voices, use of safety behaviours and subordination to persecutors were associated with depression and suicidal behaviour in acute FEP. Loss, Shame, low level continuing positive symptoms and longer duration of untreated psychosis were associated with post psychotic depression. Negative appraisals remained stable despite recovery in other symptom domains. Thus, depression and risk in early psychosis may be propagated by the personal significance and content of positive symptoms experienced. When in recovery, low level symptoms, longer period of illness and negative appraisals are significant factors.
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Affiliation(s)
- Rachel Upthegrove
- University of Birmingham, School of Clinical and Experimental Medicine, Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service, Birmingham, UK.
| | - Kerry Ross
- Wolverhampton Early Intervention Service, Wolverhampton, UK
| | - Katerine Brunet
- University of Birmingham, School of Psychology, Birmingham, UK
| | - Richard McCollum
- Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service, Birmingham, UK
| | - Lisa Jones
- University of Birmingham, School of Clinical and Experimental Medicine, Birmingham, UK
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Torres-González F, Ibanez-Casas I, Saldivia S, Ballester D, Grandón P, Moreno-Küstner B, Xavier M, Gómez-Beneyto M. Unmet needs in the management of schizophrenia. Neuropsychiatr Dis Treat 2014; 10:97-110. [PMID: 24476630 PMCID: PMC3897352 DOI: 10.2147/ndt.s41063] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental health specialist, and other specialists.
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Affiliation(s)
- Francisco Torres-González
- Centro de Investigación Biomédica en Red de Salud Mental, University of Granada, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Inmaculada Ibanez-Casas
- Centro de Investigación Biomédica en Red de Salud Mental, University of Granada, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, Faculty of Medicine, University of Concepcion, Chile ; Maristán Network, University of Granada, Granada, Spain
| | - Dinarte Ballester
- Sistema de Saúde Mãe de Deus, Escola Superior de Saúde, Universidade do Vale do Rio dos Sinos, Brazil ; Maristán Network, University of Granada, Granada, Spain
| | - Pamela Grandón
- Department of Psychology, Faculty of Social Sciences, University of Concepcion, Chile ; Maristán Network, University of Granada, Granada, Spain
| | - Berta Moreno-Küstner
- Andalusian Psychosocial Research Group and Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Malaga, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Miguel Xavier
- Department of Mental Health, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal ; Maristán Network, University of Granada, Granada, Spain
| | - Manuel Gómez-Beneyto
- Centro de Investigación Biomédica en Red de Salud Mental, University of Valencia, Spain ; Maristán Network, University of Granada, Granada, Spain
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19
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Sandhu A, Ives J, Birchwood M, Upthegrove R. The subjective experience and phenomenology of depression following first episode psychosis: a qualitative study using photo-elicitation. J Affect Disord 2013; 149:166-74. [PMID: 23414936 DOI: 10.1016/j.jad.2013.01.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depression following first episode psychosis (FEP) is a frequent occurrence, with profound impact on recovery and outcome. Whilst many theories exist about the causes of depression here, research to date has been based on nosology imported wholesale from affective disorder, with little primary research on the subjective experience. This study aimed to explore the subjective experience and phenomenological features of post-psychotic depression in FEP. METHOD A qualitative methodology, photo-elicitation, together with unstructured interviews, was used to characterise aspects of depression following FEP and analysed using contemporary framework analysis. RESULTS Depression was reported by participants as linked to the experience of and recovery from psychosis. The psychotic episode was a traumatic event followed by subjective doubt, shame and embarrassment. Loss and social isolation were central. Core biological symptoms did not feature. LIMITATIONS Despite the relatively small sample size, this study was able to generate in-depth data that provides useful and novel insight. Whilst generalisability is incompatible with qualitative methodology, further research using the same methodology would generate a wider range of experiences and perspectives. CONCLUSIONS Understanding this dimension of psychosis in and of itself has the potential to improve and aid development of more effective and appropriately targeted interventions and associated outcomes.
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Affiliation(s)
- Amrita Sandhu
- University of Birmingham, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, National Centre for Mental Health, Birmingham, United Kingdom
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Falkenburg J, Tracy DK. Sex and schizophrenia: a review of gender differences. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2012. [DOI: 10.1080/17522439.2012.733405] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jara Falkenburg
- Department of Psychological Medicine, Cognition, Schizophrenia and Imaging Laboratory, The Institute of Psychiatry, King’s College London, UK
- Oxleas NHS Foundation Trust, Green Parks House, Princess Royal University Hospital, Kent, UK
| | - Derek K. Tracy
- Department of Psychological Medicine, Cognition, Schizophrenia and Imaging Laboratory, The Institute of Psychiatry, King’s College London, UK
- Oxleas NHS Foundation Trust, Green Parks House, Princess Royal University Hospital, Kent, UK
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