Clinical and functional outcomes in people with schizophrenia with a high sense of well-being

Overlap and Mutual Distinctions Between Clinical Recovery and Personal Recovery in People With Schizophrenia in a One-Year Study

Recovery is a multidimensional construct that can be defined either from a clinical perspective or from a consumer-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. We aimed to longitudinally examine the overlap and mutual distinctions between clinical and personal recovery. Of 1239 people with schizophrenia consecutively recruited from the FondaMental Advanced Centers of Expertise for SZ network, the 507 present at one-year did not differ from those lost to follow-up. Clinical recovery was defined as the combination of clinical remission and functional remission. Personal recovery was defined as being in the rebuilding or in the growth stage of the Stages of Recovery Instrument (STORI). Full recovery was defined as the combination of clinical recovery and personal recovery. First, we examined the factors at baseline associated with each aspect of recovery. Then, we conducted multivariable models on the correlates of stable clinical recovery, stable personal recovery, and stable full recovery after one year. At baseline, clinical recovery and personal recovery were characterized by distinct patterns of outcome (i.e. better objective outcomes but no difference in subjective outcomes for clinical recovery, the opposite pattern for personal recovery, and better overall outcomes for full recovery). We found that clinical recovery and personal recovery predicted each other over time (baseline personal recovery for stable clinical recovery at one year; P = .026, OR = 4.94 [1.30-23.0]; baseline clinical recovery for stable personal recovery at one year; P = .016, OR = 3.64 [1.31-11.2]). In short, given the interaction but also the degree of difference between clinical recovery and personal recovery, psychosocial treatment should target, beyond clinical recovery, subjective aspects such as personal recovery and depression to reach full recovery.

Effect of Group Psychoeducation on Treatment Adherence, Quality of Life and Well-Being of Patients Diagnosed with Schizophrenia

Psychoeducation offers a holistic approach that focuses on the philosophy of health, cooperation, coping and empowerment, but it is known that experimental studies used in psychoeducation in schizophrenia are insufficient. The study was conducted with 42 schizophrenia patients using a quasi-experimental research design. Patients were evaluated using a pretest, post-test, follow-up test, "Medication Adherence Rating Scale", "Quality of Life Scale for Schizophrenia" and "Flourishing Scale". There was a significant difference between the experimental group and the control group in terms of pretest and post-test, pretest and follow-up test scores (p < 0.05). The post-test and follow-up test scores of the patients in the experimental group were determined to increase their quality of life and well-being score (p < 0.05). This study is an important contribution to the literature due to its assessment of the relationship between psychoeducation and change in treatment adherence, quality of life and levels of well-being.

Using the CHIME Personal Recovery Framework to Evaluate the Validity of the MHRM-10 in Individuals with Psychosis

The recovery movement has revealed that outcomes which focuses on just symptoms and functioning may not be holistic and that consumer-rated outcomes may contribute to a more holistic and person-centric care model. However, a brief and effective measure is required in clinical settings; hence, the aim of the current study is to evaluate the psychometric properties of the briefest personal recovery measure- Mental Health Recovery Measure-10 items, using the CHIME (Connectedness, Hope and optimism about the future, Identity, Meaning in life, Empowerment) personal recovery framework. 64 outpatients with schizophrenia or schizoaffective disorder were assessed at two time points, 2 weeks apart. Data collected included sociodemographic information, MHRM-10, Psychological factors related to the CHIME framework, in respective order: RYFF subscale positive relations with others; Herth Hope Index (HHI); Internalized Stigma of Mental Illness (ISMI) and RYFF subscale self-acceptance; World Health Organization Quality of Life- BRIEF (WHOQOL-BREF); Empowerment, and Clinical factors- symptoms as measured by Positive and Negative Syndrome Scale, functioning (PSP) and depressive symptoms (CDSS). MHRM-10 demonstrated convergent validity with CHIME personal recovery psychological factors (all ρ > 0.5). MHRM-10 had excellent internal consistency (Cronbach's alpha = 0.904) and adequate test-retest reliability (ρ = 0.742, p < 0.001). Initial factor structure analysis revealed a one factor structure. The MHRM-10 is a valid instrument for use and can serve as a tool to facilitate a more collaborative and person-centric model of care for individuals with psychosis.

Mental well-being and recovery in serious mental illness: associations between mental well-being and functional status in the Health Survey for England 2014

BACKGROUND

Mental illness and mental well-being are independent but correlated dimensions of mental health. Both are associated with social functioning (in opposite directions), but it is not known whether they modify the effects of one another. New treatment targets might emerge if improving mental well-being in people with serious mental illness improved functional outcomes independent of clinical status.

AIMS

To describe associations between mental well-being and functioning in people classified according to mental illness status.

METHOD

Cross-sectional data from 5485 respondents to the Health Survey for England 2014 were analysed. Mental illness status (including whether diagnosed by a professional) was by self-report and grouped into four categories, including 'diagnosis of serious mental illness'. Mental well-being was measured using the Warwick-Edinburgh Mental Well-Being Scale, and functioning by items from the EQ-5D. Mental distress was assessed using General Health Questionnaire (GHQ-12) items. Associations were examined using moderated regression models with group membership as an interaction term.

RESULTS

Mental well-being score was associated with (higher) functioning score (P < 0.05). This association varied between mental illness groups, even after adjusting for age, gender, ethnicity, physical health and symptoms of mental distress (F(3) = 14.60, P < 0.001). The gradient of this association was greatest for those with diagnosed serious mental illness.

CONCLUSIONS

Mental well-being was associated with higher functional status in people with mental illness, independent of the symptoms of mental distress and other confounders. The association was strongest in the diagnosed serious mental illness group, suggesting that mental well-being may be important in recovery from mental illness.

Well-being in patients with schizophrenia, mood and personality disorders attending psychiatric services in the community. A controlled study

BACKGROUND

Poor attention is paid by recent research to the prevalence of mental well-being in psychiatric patients and the comparison between groups with different diagnoses. Data suggest that the presence of mental illness does not necessarily mean the absence of well-being, particularly in stable outpatients.

METHODS

A consecutive series of 375 patients attending two community mental health centers was given the Mental Health Continuum Short Form (MHC-SF) and the Clinical Global Impression - Severity scale. Diagnoses were made after the MINI Neuropsychiatric Interview and a chart review of all relevant clinical information. The flourishing category and the three components of MHC-SF were used to rate well-being. A total of 274 controls were taken from the employees at a local firm.

RESULTS

The rates of flourishing mental health were: 33.1% schizophrenia, 36.6% bipolar disorder, 23.3% unipolar depression, 24.4% cluster B personality disorder, and 53.3% controls (p < 0.001). The comparison of the three MHC components across diagnostic groups found that unipolar depression and cluster B personality patients had significantly lower scores compared to bipolar and schizophrenia patients. Flourishing mental health was detected more often in males than females (34.9% vs. 24.1% - p < 0.05). For schizophrenia patients indices of well-being were better in those on depot medications.

CONCLUSIONS

Psychiatric outpatients with major mental illness have lower rates of well-being compared to controls, although about one-third is flourishing. Patients with unipolar depression and cluster B personality disorder may deserve special attention when planning intervention for fostering well-being.

Promoting well-being in psychosis

BACKGROUND

Traditionally, treatment of psychosis has focused on the amelioration of psychopathology and return to adequate functioning: clinical recovery although there is growing recognition of the importance of subjective experiences associated with recovery: personal recovery. Positive psychiatry extends the focus of psychiatric treatment to go beyond the reduction of psychiatric symptoms and and improvement of functional disability to promote the attainment of well-being.

AIM

This article examined the conceptualization of well-being from the context of treatment for psychosis, its relationship with clinical recovery and highlighted some of challenges and implications for mental health services in promoting well-being.

DISCUSSION

Recovery from psychosis is a complex and individual process, where well-being is more than just the absence of mental illness. Clinical and personal recovery processes may contribute to well-being although further longitudinal studies are required. A recent framework for understanding well-being in psychosis helps address the lack of consensus in this field. There is a considerable overlap between the indicators of well-being in this model and the CHIME framework for personal recovery. Thus, interventions targeting personal recovery processes may be a potential way to promote well-being. Current mental health services face a considerable challenge if they are to fulfill the dual role of reducing psychopathology and/or disability whilst concurrently addressing personal recovery to promote well-being. The attainment of well-being may not only be a desirable treatment goal in recovery-orientated mental health services but also a potential protective factor against serious mental illness.

Recovery and serious mental illness: a review of current clinical and research paradigms and future directions

INTRODUCTION

Recovery from serious mental illness has historically not been considered a likely or even possible outcome. However, a range of evidence suggests the courses of SMI are heterogeneous with recovery being the most likely outcome. One barrier to studying recovery in SMI is that recovery has been operationalized in divergent and seemingly incompatible ways: as an objective outcome versus a subjective process. Areas covered: This paper offers a review of recovery as a subjective process and recovery as an objective outcome; contrasts methodologies utilized by each approach to assess recovery; reports rates and correlates of recovery; and explores the relationship between objective and subjective forms of recovery. Expert commentary: There are two commonalities of approaching recovery as a subjective process and an objective outcome: (i) the need to make meaning out of one's experiences to engage in either type of recovery and (ii) there exist many threats to engaging in meaning making that may impact the likelihood of moving toward recovery. We offer four clinical implications that stem from these two commonalities within a divided approach to the concept of recovery from SMI.

Life satisfaction and happiness among young adults with schizophrenia

People with schizophrenia often experience persistent symptoms and impairments in community functioning; however, despite this, many individuals with the illness report high levels of well-being. We explored the level of subjective well-being in a sample of relatively young outpatients with schizophrenia and matched healthy controls. Seventy-five outpatients with schizophrenia and 72 demographically matched healthy controls, aged 18-35 years, participated in the present study. Subjective well-being was defined as a combination of happiness and satisfaction with life, each of which were measured using validated instruments. Symptom severity, insight, and cognition were also evaluated. People with schizophrenia endorsed significantly lower levels of subjective well-being than healthy controls although, there was substantial overlap in scores, and many participants with schizophrenia endorsed a high level of well-being. Both depressive symptoms and motivational deficits demonstrated significant independent predictive value for determining level of well-being. At a group level, the mean level of happiness and life satisfaction was lower among people with schizophrenia than healthy comparison participants. However, despite this mean difference, there exists marked overlap in individual scores between those with and without schizophrenia, demonstrating that many young people with schizophrenia do, in fact, endorse high levels of subjective well-being.

Predicting functional remission in patients with schizophrenia: a cross-sectional study of symptomatic remission, psychosocial remission, functioning, and clinical outcome

BACKGROUND

New approaches to assess outcome in schizophrenia include multidimensional measures such as remission, cognition, psychosocial functioning, and quality of life. Clinical and psychosocial measures have been recently introduced to assess functional outcome.

OBJECTIVE

The study presented here was designed to examine the rates of symptomatic remission, psychosocial remission, global functioning, and clinical global impressions in a sample of schizophrenia outpatients in order to assess functional remission and to identify predictive factors for functional remission.

METHODS

A total of 168 consecutive Mexican outpatients receiving pharmacological treatment at the National Institute of Psychiatry in Mexico City were enrolled in a cross-sectional study. Symptomatic remission was assessed according to the definition and criteria proposed by the Remission in Schizophrenia Working Group using the Positive and Negative Symptom Scale. Psychosocial remission was assessed according to Barak criteria using the Psychosocial Remission in Schizophrenia scale. Functioning was measured with the Global Assessment of Functioning, and clinical outcome with the Clinical Global Impressions (CGI) Scale.

RESULTS

Findings showed that 45.2% of patients fulfilled the symptomatic remission criteria, 32.1% achieved psychosocial remission, and 53% reported adequate functioning. However, the combination of these three outcome criteria - symptomatic, psychosocial remission, and functioning - indicated that 14.9% of the patients achieved our predefined functional remission outcome. The logistic regression model included five predictive variables for functional remission: (1) being employed, (2) use of atypical antipsychotics, (3) lower number of medications, (4) lower negative symptom severity, and (5) lower excitement symptom severity.

CONCLUSION

The study demonstrated that symptomatic remission, psychosocial remission, and functioning could be achievable goals for a considerable number of patients. The outcome of functional remission was achieved by a minority of patients, less than 15%. New approaches should include multidimensional measures to assess functional outcome in schizophrenia research.