1
|
Jordan G, Bassetto S, DeLuca J, Dobbs MF, Florence A, Allemang B, O'Keeffe D, Basile M, Funaro MC, Davidson L, Ben-David S, Shah J. Personal Recovery Among People at Risk for Developing Serious Mental Health Problems: A Qualitative Systematic Review. Psychiatr Serv 2024; 75:778-788. [PMID: 38410038 DOI: 10.1176/appi.ps.20230133] [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: 02/28/2024]
Abstract
OBJECTIVE Personal recovery refers to a person's pursuit of a full, meaningful life despite the potentially debilitating impact of a mental illness. An evidence base describing personal recovery among people at risk for developing a mental illness is lacking, limiting the potential for mental health services to support personal recovery. To address this gap, the authors synthesized the extant research describing personal recovery among people at risk for developing a mental illness. METHODS A systematic search of several literature databases (MEDLINE, Embase, APA PsycInfo, Web of Science Core Collection, and Cochrane Library) was conducted to retrieve qualitative and case studies and first-person accounts. The Joanna Briggs Institute guidelines for systematic reviews were followed. Included studies reported on participants at variable risk for developing a schizophrenia spectrum, bipolar, major depressive, or borderline personality disorder. Articles were retrieved through a librarian-assisted search and through use of additional strategies (e.g., expert consultation). Abstracts were screened by the research team, and themes were developed by using thematic synthesis. RESULTS The 36 included articles were synthesized, and six themes were generated: difficulties and challenges; establishing an understanding of, and finding ways to cope with, one's mental health challenges; reestablishing a sense of agency and personhood; receiving support from people and services, as well as restoring relationships; reestablishing hope, meaning, and purpose; and overcoming stigma and destigmatizing mental illness in others. CONCLUSIONS These findings provide a conceptual foundation that can guide future research on personal recovery and clinical interventions that foster it among people at risk for mental illness.
Collapse
Affiliation(s)
- Gerald Jordan
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Stella Bassetto
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Joseph DeLuca
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Matthew F Dobbs
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Ana Florence
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Brooke Allemang
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Donal O'Keeffe
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Mikaela Basile
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Melissa C Funaro
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Larry Davidson
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Shelly Ben-David
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| | - Jai Shah
- Institute for Mental Health, Centre for Urban Wellbeing, School of Psychology, University of Birmingham, Birmingham, United Kingdom (Jordan); Department of Psychiatry, McGill University, Montreal (Bassetto, Shah); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (DeLuca, Dobbs); Department of Psychological & Brain Sciences, Fairfield University, Fairfield, Connecticut (DeLuca); New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Florence); Faculty of Social Work, University of Calgary, Calgary, Canada (Allemang); ARCHES Recovery College, Mental Health Ireland, Dublin (Ó'Keeffe); School of Social Work, University of British Columbia, Kelowna, Canada (Basile, Ben-David); Harvey Cushing/John Hay Whitney Medical Library (Funaro) and Yale Program for Recovery and Community Health, Department of Psychiatry (Davidson), Yale University, New Haven
| |
Collapse
|
2
|
Cowan HR, McAdams DP, Ouellet L, Jones CM, Mittal VA. Self-concept and Narrative Identity in Youth at Clinical High Risk for Psychosis. Schizophr Bull 2024; 50:848-859. [PMID: 37816626 PMCID: PMC11283199 DOI: 10.1093/schbul/sbad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND HYPOTHESIS Disturbances of the narrative self and personal identity accompany the onset of psychotic disorders in late adolescence and early adulthood (a formative developmental stage for self-concept and personal narratives). However, these issues have primarily been studied retrospectively after illness onset, limiting any inferences about their developmental course. STUDY DESIGN Youth at clinical high risk for psychosis (CHR) (n = 49) and matched healthy comparison youth (n = 52) completed a life story interview (including self-defining memory, turning point, life challenge, and psychotic-like experience) and questionnaires assessing self-esteem, self-beliefs, self-concept clarity, and ruminative/reflective self-focus. Trained raters coded interviews for narrative identity themes of emotional tone, agency, temporal coherence, context coherence, self-event connections, and meaning-making (intraclass correlations >0.75). Statistical analyses tested group differences and relationships between self-concept, narrative identity, symptoms, and functioning. STUDY RESULTS CHR participants reported more negative self-esteem and self-beliefs, poorer self-concept clarity, and more ruminative self-focus, all of which related to negative symptoms. CHR participants narrated their life stories with themes of negative emotion and passivity (ie, lack of personal agency), which related to positive and negative symptoms. Reflective self-focus and autobiographical reasoning were unaffected and correlated. Autobiographical reasoning was uniquely associated with preserved role functioning. CONCLUSIONS This group of youth at CHR exhibited some, but not all, changes to self-concept and narrative identity seen in psychotic disorders. A core theme of negativity, uncertainty, and passivity ran through their semantic and narrative self-representations. Preserved self-reflection and autobiographical reasoning suggest sources of resilience and potential footholds for cognitive-behavioral and metacognitive interventions.
Collapse
Affiliation(s)
- Henry R Cowan
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Dan P McAdams
- Psychology, Northwestern University, Evanston, IL, USA
| | - Leah Ouellet
- Human Development and Social Policy, Northwestern University, Evanston, IL, USA
| | | | | |
Collapse
|
3
|
Zhu X, Yang Y, Xiao Z, Pooley A, Ozdemir E, Speyer LG, Leung M, Thurston C, Kwok J, Li X, Eisner M, Ribeaud D, Murray AL. Daily life affective dynamics as transdiagnostic predictors of mental health symptoms: An ecological momentary assessment study. J Affect Disord 2024; 351:808-817. [PMID: 38320660 DOI: 10.1016/j.jad.2024.01.269] [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: 07/28/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Affective dynamics have been identified as a correlate of a broad span of mental health issues, making them key candidate transdiagnostic factors. However, there remains a lack of knowledge about which aspects of affective dynamics - especially as they manifest in the course of daily life - relate to a general risk for mental health issues versus specific symptoms. METHODS We leverage an ecological momentary assessment (EMA) study design with four measures per day over a two-week period to explore how negative affect levels, inertia, lability, and reactivity to provocation and stress in the course of daily life relate to mental health symptoms in young adults (n = 256) in the domains of anxiety, depression, psychosis-like symptoms, behaviour problems, suicidality, and substance use. RESULTS Dynamic structural equation modelling (DSEM) suggested that negative affect levels in daily life were associated with depression, anxiety, indirect and proactive aggression, psychosis, anxiety, and self-injury; negative affective lability was associated with depression, physical aggression, reactive aggression, suicidal ideation, and ADHD symptoms; negative affective inertia was associated with depression, anxiety, physical aggression, and cannabis use; and emotional reactivity to provocation was related to physical aggression. LIMITATIONS The cross-sectional design, the limited span of mental health issues included, and the convenience nature and small size of the sample are limitations. CONCLUSIONS Findings suggest that a subset of mental health symptoms have shared negative affective dynamics patterns. Longitudinal research is needed to rigorously examine the directionality of the effects underlying the association between affective dynamics and mental health issues.
Collapse
Affiliation(s)
- Xinxin Zhu
- Department of Psychology, University of Edinburgh, UK
| | - Yi Yang
- Department of Psychology, University of Edinburgh, UK
| | - Zhuoni Xiao
- Department of Psychology, University of Edinburgh, UK
| | - Abby Pooley
- Department of Psychology, University of Edinburgh, UK
| | - Ercan Ozdemir
- School of Health in Social Science, University of Edinburgh, UK
| | - Lydia Gabriela Speyer
- Department of Psychology, University of Edinburgh, UK; Department of Psychology, Lancaster University, UK
| | | | | | - Janell Kwok
- Department of Psychology, University of Edinburgh, UK
| | - Xuefei Li
- Department of Psychology, University of Edinburgh, UK
| | - Manuel Eisner
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland; Institute of Criminology, University of Cambridge, UK
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland
| | | |
Collapse
|
4
|
Conneely M, Roe D, Hasson-Ohayon I, Pijnenborg GHM, van der Meer L, Speyer H. Antipsychotics and Identity: The Adverse Effect No One is Talking About. Community Ment Health J 2024:10.1007/s10597-024-01255-w. [PMID: 38427277 DOI: 10.1007/s10597-024-01255-w] [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: 12/12/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
People who take antipsychotics, and people who are prescribed antipsychotics without taking them, experience effects which are not frequently discussed: effects on their identity and sense of self. Qualitative research indicates the relationship between taking APs and identity is multilayered, and changeable. Taking APs can restore people to their earlier, pre-symptom sense of self. Being prescribed and taking APs can also, on the other hand, be experienced as damaging, erasing and dulling people's sense of who they are. This complexity deserves exploration in clinical practice, which we believe is currently not done routinely. More work is needed to understand whether, and how, the relationship between identity and APs is being addressed. We outline the importance of having discussions in a clinical space around identity, and a sense of agency, on the grounds that true recovery-oriented care, which enacts shared decision-making principles, demands it. Further, we argue that it will allow for better therapeutic alliance and trust to be forged between clinician and client, ultimately leading to better care.
Collapse
Affiliation(s)
- M Conneely
- Division of Psychiatry, University College London, Maple House, W1T 7BN, London, UK.
| | - D Roe
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - I Hasson-Ohayon
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - G H M Pijnenborg
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - L van der Meer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - H Speyer
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Xavier SM, Barbosa S, Correia AF, Dindo V, Sequeira M, Maia T, Goes AR. Images that speak: A Portuguese Photovoice study on the psychosocial experience of a migrant population from Cape Verde after a first episode of psychosis. Transcult Psychiatry 2023:13634615231187252. [PMID: 37519012 DOI: 10.1177/13634615231187252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Several migrant populations have been identified worldwide as high-risk groups for psychosis because of their experience of social adversity. Recent evidence suggests that the local contexts in which these populations live should be addressed in their complexity to take into account individual and larger societal environmental aspects. This study aimed to assess the lived experiences of a group of migrant Cape Verdean patients, who had been recently hospitalized for a first episode of psychosis in a mental health service on the outskirts of Lisbon, Portugal. The study used Photovoice, a qualitative participatory research method in which people's experiences are documented through photography. Six individuals were recruited, and five weekly sessions were conducted to collect data that were analyzed thematically. Emergent themes addressed two main categories of well-being and illness. Participant concepts of well-being were rooted in a definition of freedom encompassing cultural expression, conveyed by familiar environments and supporting communities. Cultural differences may be experienced as important obstacles for well-being and can be associated with feelings of oppression and guilt. Participants' accounts focused on positive aspects of life despite illness and on personal concepts of recovery. The study findings contribute to knowledge of the dynamics of migrants' social experience and underscore the importance of socially and culturally informed mental healthcare institutions.
Collapse
Affiliation(s)
| | | | | | - Vera Dindo
- Hospital Professor Doutor Fernando Fonseca
- Sahlgrenska University Hospital
| | - Márcia Sequeira
- Hospital Professor Doutor Fernando Fonseca
- Hunter New England Health District
| | | | | |
Collapse
|
6
|
Farr J, Rhodes JE, Baruch E, Smith JA. First episode psychotic mania and its aftermath: the experience of people diagnosed with bipolar disorder. PSYCHOSIS 2023. [DOI: 10.1080/17522439.2022.2163686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Joanna Farr
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - John E. Rhodes
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Ella Baruch
- Tower Hamlets Early Intervention Service, London, UK
| | - Jonathan A. Smith
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| |
Collapse
|
7
|
Early Maladaptive Schemas and Mental Disorders in Adulthood: a Systematic Review and Meta-analysis. Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AbstractEarly maladaptive schemas (EMSs) are broad and pervasive themes regarding oneself and one’s relationships with others originating from adverse childhood experiences. Although the concept of EMSs was initially developed for the treatment of personality disorders, the associations of EMSs with a variety of other mental disorders have been investigated. The goal of the present study was to summarize and analyze the EMSs-disorder associations in studies in which patients with specific psychiatric diagnoses were compared to healthy controls. Of the 28 studies that met the inclusion criteria, 27 were included in a meta-analysis. Across diagnoses, all EMSs were elevated in the clinical groups. The largest effect sizes were observed for the social isolation, the negativity/pessimism, the defectiveness/shame, and social undesirability schemas. Depression (n = 8), borderline personality disorder (n = 5), and obsessive–compulsive disorder (n = 5) were the most frequently studied mental disorders. Heterogeneity between studies was high. Results suggest that mental disorders are not characterized by specific EMSs.
Collapse
|
8
|
Harris O, Lawes A, Andrews C, Jacobsen P. Kintsugi-Identity change and reconstruction following an episode of psychosis: A systematic review and thematic synthesis. Early Interv Psychiatry 2022; 16:689-714. [PMID: 34541814 DOI: 10.1111/eip.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 08/02/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
AIM Research has shown that experiences of psychosis can have a significant impact on an individual's identity. Moreover, the way those who experience psychosis make sense of these changes appears to affect their recovery journey and hold clinical significance. However, this area of research is still very much developing, and there is a need for reviews, which look to synthesise and understand this process of identity change to guide clinicians working in this area as well as future research. This study looks to meet that gap and aims to synthesise qualitative literature exploring the lived experience of identity change amongst people who experience psychosis. METHODS A systematic review using thematic synthesis was carried out. The PRISMA and ENTREQ guidelines were followed in reporting the study. RESULTS Ninety-one papers were identified which met criteria for inclusion and 31 papers included in the synthesis at which point conceptual saturation was judged to have been reached. Five themes were created: psychosis as an obliteration of the old self; the futile fight against psychosis; mourning for who I was; the battle for self as a battle against disempowerment; and recovery as rebirth. CONCLUSIONS Results highlighted the substantive impact an experience of psychosis has on an individual's identity, the key role sense making around these identity changes plays in recovery and the crucial impact of clinicians on the sense-making process. The implications for theory, future research and clinical practice are discussed.
Collapse
Affiliation(s)
- Olivia Harris
- Department of Psychology, University of Bath, Bath, UK
| | - Anna Lawes
- Department of Psychology, University of Bath, Bath, UK
| | | | | |
Collapse
|
9
|
Branjerdporn G, Robertson J, Dymond A. Factors associated with Health of the Nation Outcomes Scales (HoNOS) in an acute young adult psychiatric unit. Int J Ment Health Nurs 2022; 31:313-325. [PMID: 34821012 DOI: 10.1111/inm.12958] [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: 07/15/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
The transition from adolescence to adulthood is a highly vulnerable period for mental health concerns and is a key life-stage, fundamental to later health and quality of life. Scant research has investigated the health outcomes of young adults admitted to a specialised acute psychiatric unit for this cohort. Understanding health and functional outcomes for young adults admitted to a specialised acute mental health inpatient unit is beneficial in identifying treatment effectiveness and vulnerable groups. The study examines the relationship between demographic and clinical factors with admission, discharge and change in Health of the Nation Outcomes Scale (HoNOS) scores in patients admitted to an acute young adult psychiatric unit. The HoNOS was completed at admission and discharge for patients admitted to an acute young adult psychiatric unit in Australia. Descriptive statistics, paired t-tests, generalised estimating equations, independent samples t-tests and correlations were completed. Patients (N = 130) were aged between 18 and 25 years old (M = 21.26 years old, SD = 2.31). Patients were diagnosed with mood disorders (21.54%), substance abuse disorders (20.00%), personality disorders (19.23%), and psychotic disorders (17.69%). HoNOS scores across all subscales improved from admission to discharge, when controlling for confounding variables. Admission, discharge and change in HoNOS scores were associated with gender, country of birth, number of admissions, mental health act, diagnosis and socioeconomic status. This study is the first to explore HoNOS scores, demographic factors and clinical variables in young adults admitted to a specialised psychiatric inpatient unit for this age group. While further research is required, the findings identifies vulnerable subgroups (e.g., individuals with personality disorders, individuals with substance use, those admitted involuntarily, those readmitted) that may benefit from increased tailored support to foster more optimal health outcomes.
Collapse
Affiliation(s)
- Grace Branjerdporn
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Julia Robertson
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Alex Dymond
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| |
Collapse
|
10
|
DeLuca JS, Novacek DM, Adery LH, Herrera SN, Landa Y, Corcoran CM, Walker EF. Equity in Mental Health Services for Youth at Clinical High Risk for Psychosis: Considering Marginalized Identities and Stressors. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:176-197. [PMID: 35815004 PMCID: PMC9258423 DOI: 10.1080/23794925.2022.2042874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Prevention and early intervention programs have been initiated worldwide to serve youth at Clinical High Risk for Psychosis (CHR-P), who are adolescents and young adults experiencing subclinical psychosis and functional impairment. The primary goals of these efforts are to prevent or mitigate the onset of clinical psychosis, while also treating comorbid issues. It is important to consider issues of diversity, equity, and inclusion in CHR-P work, especially as these programs continue to proliferate around the world. Further, there is a long history in psychiatry of misdiagnosing and mistreating psychosis in individuals from racial and ethnic minority groups. Although there have been significant developments in early intervention psychosis work, there is evidence that marginalized groups are underserved by current CHR-P screening and intervention efforts. These issues are compounded by the contexts of continued social marginalization and significant mental health disparities in general child/adolescent services. Within this narrative review and call to action, we use an intersectional and minority stress lens to review and discuss current issues related to equity in CHR-P services, offer evidence-based recommendations, and propose next steps. In particular, our intersectional and minority stress lenses incorporate perspectives for a range of marginalized and underserved identities related to race, ethnicity, and culture; faith; immigration status; geography/residence; gender identity; sexual orientation; socioeconomic status/class; and ability status.
Collapse
Affiliation(s)
- Joseph S. DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
| | - Derek M. Novacek
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, , Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Laura H. Adery
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Shaynna N. Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
- New York Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
- New York Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Elaine F. Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
11
|
van der Zeijst MCE, Veling W, Makhathini EM, Mbatha ND, Shabalala SS, van Hoeken D, Susser E, Burns JK, Hoek HW. Course of psychotic experiences and disorders among apprentice traditional health practitioners in rural South Africa: 3-year follow-up study. Front Psychiatry 2022; 13:956003. [PMID: 36245859 PMCID: PMC9558832 DOI: 10.3389/fpsyt.2022.956003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Culture is inevitably linked with the experience, interpretation and course of what modern biomedicine understands to be psychotic symptoms. However, data on psychoses in low- and middle-income countries are sparse. Our previous study showed that psychotic and mood-related experiences, symptoms and disorders are common among individuals who had received the ancestral calling to become a traditional health practitioner (THP) in rural KwaZulu-Natal, South Africa. Our related ethnographic study suggested that ukuthwasa (the training to become a THP) may positively moderate these calling-related symptoms. As far as we know, no research has been conducted into the course of psychiatric symptoms among apprentice THPs. OBJECTIVE We studied the course of psychotic experiences, symptoms and disorders among apprentice THPs. We also assessed their level of functioning and expanded our knowledge on ukuthwasa. MATERIALS AND METHODS We performed a 3-year follow-up of a baseline sample of apprentice THPs (n = 48). Psychiatric assessments (CAPE, SCAN), assessment of functioning (WHODAS) and a semi-structured qualitative questionnaire were completed for 42 individuals. RESULTS At 3-year follow-up, psychotic experiences were associated with significantly less distress and there was a reduction in frequency of psychotic symptoms compared to baseline. The number of participants with psychotic disorders had decreased from 7 (17%) to 4 (10%). Six out of seven participants (86%) with a psychotic disorder at baseline no longer had a psychiatric diagnosis at follow-up. Although the mean level of disability among the (apprentice) THPs corresponded with the 78th percentile found in the general population, 37 participants (88%) reported no or mild disability. Forty-one participants (98%) reported that ukuthwasa had positively influenced their psychiatric symptoms. CONCLUSION In rural KwaZulu-Natal, psychotic experiences, symptoms and disorders have a benign course in most individuals who are undergoing the process of becoming a THP. Ukuthwasa may be an effective, culturally sanctioned, healing intervention for some selected individuals, potentially because it reframes distressing experiences into positive and highly valued experiences, reduces stigma, and enhances social empowerment and identity construction. This implies that cultural and spiritual interventions can have a positive influence on the course of psychosis.
Collapse
Affiliation(s)
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Elliot M Makhathini
- Department of Nursing, Durban University of Technology, Pietermaritzburg, South Africa.,Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ndukuzakhe D Mbatha
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sinethemba S Shabalala
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.,New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Jonathan K Burns
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.,Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, Netherlands.,Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| |
Collapse
|
12
|
Ben-David S, Kealy D, Hanson J, Ortiz R. Perspectives on personal identity in the early stages of psychosis: A survey of Canadian clinicians. Early Interv Psychiatry 2021; 15:1038-1043. [PMID: 32881357 DOI: 10.1111/eip.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/13/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022]
Abstract
AIM Identity-related concerns represent an important aspect of young people's experience in early psychosis. Knowledge regarding clinicians' perspectives on this issue, however, is limited. Thus, the present study was developed to understand Canadian clinicians' perspectives on personal identity-related concerns in early psychosis. METHODS An online survey was distributed to 331 multiprofessional clinicians working in early psychosis intervention programs in a Canadian province. Clinicians were asked about their opinions regarding the salience of identity in early psychosis using Likert-rated items and open response questions. RESULTS Nearly all of the clinicians agreed that identity is an important issue for clinical attention, yet only half of the clinicians endorsed a high level of confidence in their ability to address issues related to identity in treatment. Although several clinical strategies were identified, specific evidence-based approaches for strengthening identity in early psychosis remain lacking. CONCLUSIONS Findings indicate a need for early psychosis programs to invest in identity- related training for clinicians.
Collapse
Affiliation(s)
- Shelly Ben-David
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Hanson
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| | - Radha Ortiz
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| |
Collapse
|
13
|
Corsico P. "It's all about delivery": researchers and health professionals' views on the moral challenges of accessing neurobiological information in the context of psychosis. BMC Med Ethics 2021; 22:11. [PMID: 33557813 PMCID: PMC7869514 DOI: 10.1186/s12910-020-00551-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
Background The convergence of neuroscience, genomics, and data science holds promise to unveil the neurobiology of psychosis and to produce new ways of preventing, diagnosing, and treating psychotic illness. Yet, moral challenges arise in neurobiological research and in the clinical translation of research findings. This article investigates the views of relevant actors in mental health on the moral challenges of accessing neurobiological information in the context of psychosis. Methods Semi-structured individual interviews with two groups: researchers employed in the National Health Service (NHS) or a university in England (n = 14), and mental health professionals employed in NHS mental health services (n = 14). This article compares results in the two groups (total n = 28). Results This article presents findings around three conceptual areas: (1) research ethics as mostly unproblematic, (2) psychosis, neurobiological information, and mental health care, and (3) identity, relationships, and the future. These areas are drawn from the themes and topics that emerged in the interviews across the two groups of participants. Researchers and health professionals provided similar accounts of the moral challenges of accessing—which includes acquisition, communication, and use of—neurobiological information in the context of psychosis. Acquiring neurobiological information was perceived as mostly unproblematic, provided ethical safeguards are put in place. Conversely, participants argued that substantive moral challenges arise from how neurobiological information is delivered—that is, communicated and used—in research and in clinical care. Neurobiological information was seen as a powerful tool in the process through which individuals define their identity and establish personal and clinical goals. The pervasiveness of this narrative tool may influence researchers and health professionals’ perception of ethical principles and moral obligations. Conclusions This study suggests that the moral challenges that arise from accessing neurobiological information in the context of psychosis go beyond traditional research and clinical ethics concerns. Reflecting on how accessing neurobiological information can influence individual self-narratives will be vital to ensure the ethical translation of neuroscience and genomics into mental health. Trial registration The study did not involve a health care intervention on human participants. It was retrospectively registered on 11 July 2018, registration number: researchregistry4255.
Collapse
Affiliation(s)
- Paolo Corsico
- Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
| |
Collapse
|
14
|
Conneely M, McNamee P, Gupta V, Richardson J, Priebe S, Jones JM, Giacco D. Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis. Schizophr Bull 2020; 47:309-322. [PMID: 32989443 PMCID: PMC7965068 DOI: 10.1093/schbul/sbaa124] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Experiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature. METHODS Electronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis. RESULTS Of 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss. CONCLUSIONS Our conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.
Collapse
Affiliation(s)
- Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK,To whom correspondence should be addressed; Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK; tel: +44 020 7540 4380 (ext.: 2308), fax: +44 020 7540 4380, e-mail:
| | - Philip McNamee
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Veenu Gupta
- Department of Primary Care and Mental health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - John Richardson
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Janelle M Jones
- Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|