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Maas IL, Bohlken MM, Gangadin SS, Rosema BS, Veling W, Boonstra N, de Haan L, Begemann MJH, Koops S. Personal recovery in first-episode psychosis: Beyond clinical and functional recovery. Schizophr Res 2024; 266:32-40. [PMID: 38367610 DOI: 10.1016/j.schres.2024.02.005] [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: 04/14/2023] [Revised: 01/24/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The concept of personal recovery after psychotic illness focuses more on patients' social and existential needs compared to traditional outcome measures including clinical and functional recovery. This research aims to contribute to a broad framework on (personal) recovery and associated factors. METHODS Data from 203 persons with symptomatic remission of their first-episode psychosis from the ongoing HAMLETT study were analyzed. To determine the relative importance of several biological, clinical, psychological, and social factors in explaining personal recovery as measured by the Recovery Assessment Scale (RAS), partial Spearman correlations (controlling for clinical recovery (PANSS) and functional recovery (WHODAS 2.0)) and a bootstrapped multiple regression were performed. Indirect effects on personal recovery within these factors, clinical recovery, and functional recovery were explored using a regularized partial correlation network. RESULTS Of the factors that explained personal recovery beyond the effects of clinical and functional recovery, social support was the strongest predictor, followed by self-esteem, internalized stigma, and insecure attachment, collectively explaining 48.2 % of the variance. Anhedonia/apathy showed a trend towards a negative correlation. Age at onset, sex, early trauma/neglect, cognition, and being married/cohabiting did not significantly correlate with personal recovery. The network (n = 143) was consistent with these findings and indicated possible mediation pathways for early trauma/neglect, insecure attachment, cognition, and being married/cohabiting. CONCLUSIONS Personal recovery is an important addition to traditional measures of outcome after psychosis. Various quality of life indicators, such as self-esteem and social support, explain variance in personal recovery over clinical and functional recovery.
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Affiliation(s)
- Isolde L Maas
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc M Bohlken
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Shiral S Gangadin
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bram-Sieben Rosema
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim Veling
- 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
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Marieke J H Begemann
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sanne Koops
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Bourke E, Barker C, Fornells-Ambrojo M. Systematic review and meta-analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis. Psychol Psychother 2021; 94:822-853. [PMID: 33569885 DOI: 10.1111/papt.12330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/16/2021] [Indexed: 01/07/2023]
Abstract
AIM The moderate association between therapeutic alliance (TA) and psychological therapy outcome is well established. Historically, the field has not focused on people with a severe mental illness. This is the first review to conduct a meta-analysis of associations between TA and therapeutic engagement as well as outcome in psychological therapy for psychosis. ELIGIBILITY CRITERIA Eligible studies conducted a quantitative investigation of the relationship between TA during a psychological therapy and outcome at a subsequent time-point. METHOD A systematic review examined the relationship between TA and engagement as well as outcome measures within psychological therapy for psychosis. Correlational meta-analyses using an aggregate random effects model were conducted. RESULTS Twenty-four studies were eligible for inclusion (n = 1,656) of which 13 were included in the meta-analyses. Client- and therapist-rated TA were associated with engagement in therapy (rclient (c) = 0.36, p = .003; rtherapist (t) = 0.40, p = .0053). TA was also associated with reduction in global (rc = 0.29, p = .0005; rt = 0.24, p = .0015) and psychotic symptoms (rc = 0.17, p = .0115; rt = 0.30, p = .0003). The systematic review identified no evidence or limited evidence for a relationship between TA during therapy and depression, substance use, physical health behaviours, global as well as social functioning, overall mental health recovery, and self-esteem at follow-up. Although number of studies was small, TA was related to a reduced risk of subsequent hospitalization in 40% of analyses (across two studies) and improved cognitive outcome in 50% of analyses (across three studies). CONCLUSIONS The observed TA-therapy engagement and TA-outcome associations were broadly consistent with those identified across non-psychotic diagnostic groups. Well-powered studies are needed to investigate the relationship between TA and process as well as outcome in psychological therapy for psychosis specifically. PRACTITIONER POINTS This is the first review to conduct a meta-analytic synthesis of the association between therapeutic alliance (TA) and both engagement and change in outcome in psychological therapies for psychosis. TA (as rated by therapist and client) was associated with the extent of therapeutic engagement as well as reduction in global mental health symptoms and psychotic symptoms. The significant associations between TA and engagement as well as change in outcome identified in the current review are broadly consistent with those observed across non-psychotic diagnostic groups. We consider factors that could impact upon the dynamic and potentially interdependent relationships between TA and therapeutic techniques, including attachment security and severity of paranoid ideation.
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Affiliation(s)
- Emilie Bourke
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chris Barker
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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3
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Taylor CD, Harper SF. Early maladaptive schema, social functioning and distress in psychosis: A preliminary investigation. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher D.j. Taylor
- Early Intervention Service, Lancashire Care NHS Foundation Trust, Accrington, UK,
- School of Psychological Sciences, University of Manchester, Manchester, UK,
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McGonagle G, Bucci S, Varese F, Raphael J, Berry K. Is adult attachment associated with engagement with services? A systematic literature review. J Ment Health 2019; 30:607-618. [DOI: 10.1080/09638237.2019.1608922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- G. McGonagle
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S. Bucci
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - F. Varese
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J. Raphael
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - K. Berry
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Bucci S, Emsley R, Berry K. Attachment in psychosis: A latent profile analysis of attachment styles and association with symptoms in a large psychosis cohort. Psychiatry Res 2017; 247:243-249. [PMID: 27930965 DOI: 10.1016/j.psychres.2016.11.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/20/2016] [Accepted: 11/24/2016] [Indexed: 11/28/2022]
Abstract
Attachment has been identified as one of various possible mechanisms involved in understanding models of psychosis, but measures that reliably and validly assess attachment styles in psychosis are limited. The aim of this study was to identify attachment patterns in psychosis and examine demographic and clinical correlates across attachment groups. Latent profile analysis on attachment data from 588 participants who met criteria for non-affective psychosis was used to classify people into attachment classes. Four latent classes of attachment were identified: secure, insecure-anxious, insecure-avoidant and disorganised. Secure attachment was the most common attachment style, suggesting that a significant number of clients with psychosis are inherently resilient. Disorganised attachment was associated with a higher proportion of sexual and physical abuse and more severe positive symptoms compared to other attachment classes. This is not only the largest study to examine attachment styles, their demographic and clinical profile, and the clinical profile of disorganised attachment more specifically, in psychosis, but also the first study to use a validated self-report measure of attachment in psychosis to identify four classes of attachment style. Findings advance developmental models of attachment and psychosis; participants with disorganised attachment report more frequent trauma history and more severe psychotic symptoms.
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Affiliation(s)
- Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, 22nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom.
| | - Richard Emsley
- Division of Population Health, Health Services Research & Primary Care, Centre for Biostatistics, Institute of Population Health, The University of Manchester, 1.304 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, 22nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom
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Huguelet P, Mohr S, Rieben I, Hasler R, Perroud N, Brandt PY. Attachment and coping in psychosis in relation to spiritual figures. BMC Psychiatry 2015; 15:237. [PMID: 26446496 PMCID: PMC4597457 DOI: 10.1186/s12888-015-0617-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/28/2015] [Indexed: 11/21/2022] Open
Abstract
Background Studies have found higher levels of insecure attachment in individuals with schizophrenia. Attachment theory provides a framework necessary for conceptualizing the development of interpersonal functioning. Some aspects of the attachment of the believer to his/her spiritual figure are similar to those between the child and his/her parents. The correspondence hypothesis suggests that early child-parent interactions correspond to a person’s relation to a spiritual figure. The compensation hypothesis suggests that an insecure attachment history would lead to a strong religiousness/spirituality as a compensation for the lack of felt security. The aim of this study is to explore attachment models in psychosis vs. healthy controls, the relationships between attachment and psychopathology and the attachment processes related to spiritual figures. Methods Attachment models were measured in 30 patients with psychosis and 18 controls with the AAI (Adult Attachment interview) in relationship with psychopathology. Beliefs and practices related to a spiritual figure were investigated by qualitative and quantitative analyses. Results Patients with psychosis showed a high prevalence of insecure avoidant attachment. Spiritual entities functioned like attachment figures in two thirds of cases. Interviews revealed the transformation of internal working models within relation to a spiritual figure: a compensation process was found in 7 of the 32 subjects who showed a significant attachment to a spiritual figure. Conclusions Attachment theory allows us to highlight one of the underlying dimensions of spiritual coping in patients with psychosis.
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Affiliation(s)
- Philippe Huguelet
- Division of Adult Psychiatry, University Hospital of Geneva and University of Geneva, Rue du 31-Décembre 8, 1207, Geneva, Switzerland. .,Department of Mental Health and Psychiatry, Division of General Psychiatry, Secteur Eaux-Vives, University Hospital of Geneva, Rue du 31 Décembre 8, 1207, Geneva, Switzerland.
| | - Sylvia Mohr
- Division of Adult Psychiatry, University Hospital of Geneva and University of Geneva, Rue du 31-Décembre 8, 1207, Geneva, Switzerland.
| | - Isabelle Rieben
- Faculty of Theology, Lausanne University, BFSH 2, 1015, Lausanne, Switzerland.
| | - Roland Hasler
- Division of Adult Psychiatry, University Hospital of Geneva and University of Geneva, Rue du 31-Décembre 8, 1207, Geneva, Switzerland.
| | - Nader Perroud
- Division of Adult Psychiatry, University Hospital of Geneva and University of Geneva, Rue du 31-Décembre 8, 1207, Geneva, Switzerland.
| | - Pierre-Yves Brandt
- Faculty of Theology, Lausanne University, BFSH 2, 1015, Lausanne, Switzerland.
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Meng X, D'Arcy C, Adams GC. Associations between adult attachment style and mental health care utilization: Findings from a large-scale national survey. Psychiatry Res 2015. [PMID: 26213376 DOI: 10.1016/j.psychres.2015.05.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigated the association between attachment style and the use of a range of mental health services controlling socio-demographic, physical and psychological risk factors. Using a large nationally representative sample from the US National Comorbidity Survey Replication (NCS-R), a total of 5645 participants (18+) were included. The majority of participants reported their attachment as secure (63.5%), followed by avoidant (22.2%), unclassified (8.8%), and anxious (5.5%). The percentages using different health services studied varied widely (1.1-31.1%). People with insecure (anxious and avoidant) attachment were more likely to report accessing a hotline, having had a session of psychological counselling or therapy, getting a prescription or medicine for mental and behavioural problems. Individuals with anxious attachment only were also more likely to report the use of internet support groups or chat rooms. This is a first analysis to explore relationships between self-reported adult attachment style and a wide range of health care services. Insecurely attached individuals were more likely to use a wide range of health care services even after controlling for socio-demographic factors, psychiatric disorders and chronic health conditions. These findings suggest that adult attachment plays an important role in the use of mental health care services.
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Affiliation(s)
- Xiangfei Meng
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Canada
| | - Carl D'Arcy
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada
| | - G Camelia Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada.
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Abstract
BACKGROUND The capacity to manage affects is rooted in early interactions with caregivers, which in adulthood are internalized as different attachment styles. Few studies have explored associations between all four attachment styles and symptoms. AIM Our aim was to investigate the relations between the four attachment styles and psychological distress in a group of people with psychosis. METHOD In a cross-sectional study, associations between self-reported attachment style and symptoms in a psychosis group were explored. Attachment styles were measured with the Relationship Questionnaire (RQ) and symptoms were assessed with the revised version of the Symptom Checklist (SCL-90R) RESULTS: The analyses showed a significant positive association between preoccupied attachment and the severity of symptoms. Furthermore, the analyses indicated significant positive associations between preoccupied attachment and the subscales measuring depression, anxiety, interpersonal sensitivity, paranoia and psychoticism. We also found significant positive associations between fearful attachment and both interpersonal sensitivity and psychoticism. CONCLUSION The associations between attachment styles and symptoms found here are consistent with those of previous studies. It could be important for clinicians to identify patients' attachment styles. Such knowledge would help mental health professionals to understand better the patients' capacity to handle distress and help professionals to address interventions aiming to target each patient's specific needs.
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Affiliation(s)
- Jennifer Strand
- Jennifer Strand, Department of Psychology, University of Gothenburg , PO Box 500, S-405 30 Gothenburg , Sweden
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Korver-Nieberg N, Berry K, Meijer CJ, de Haan L. Adult attachment and psychotic phenomenology in clinical and non-clinical samples: a systematic review. Psychol Psychother 2014; 87:127-54. [PMID: 23818184 DOI: 10.1111/papt.12010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 03/07/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVES It has been argued that attachment theory could enhance our knowledge and understanding of psychotic phenomenology. DESIGN We systematically reviewed and critically appraised research investigating attachment and psychotic phenomenology in clinical and non-clinical samples. METHODS We searched databases Pub Med, PsycINFO, Medline and Web of Science using the keywords. Attachment, Adult Attachment, Psychosis, Schizotypy and Schizophrenia and identified 29 studies assessing adult attachment in combination with psychotic phenomenology. RESULT The findings indicated that both insecure anxious and insecure avoidant attachment are associated with psychotic phenomenology. Insecurely attached individuals are more vulnerable to developing maladaptive coping strategies in recovering from psychosis. The importance of attachment experiences for processing social information, mentalization skills and developing social relationships, including therapeutic relationships, in samples with psychosis is also highlighted. CONCLUSION Attachment style is a clinically relevant construct in relation to development, course and treatment of psychosis. PRACTITIONER POINTS Understanding the role of attachment in symptoms may help to gain insight into the development or persistence of symptoms. Associations between attachment and recovery style suggest that it may be helpful to improve attachment security in a context of therapeutic relationships or other social relationships before encouraging people to explore their experiences of psychosis. Associations between insecure attachment and impaired mentalization skills may help in understanding interpersonal difficulties and this knowledge can be used to improve recovery.
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Affiliation(s)
- Nikie Korver-Nieberg
- Department Early Psychosis, Academic Psychiatric Center, Amsterdam, The Netherlands
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Gumley AI, Taylor HEF, Schwannauer M, MacBeth A. A systematic review of attachment and psychosis: measurement, construct validity and outcomes. Acta Psychiatr Scand 2014; 129:257-74. [PMID: 23834647 DOI: 10.1111/acps.12172] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This review sought to identify, summarise and critically evaluate studies that investigated attachment amongst individuals with psychosis. METHOD The following computerised databases searched were CINAHL<1980 to December 2012; EMBASE<1980 to December 2012; Ovid MEDLINE (R)<1980 to December 2012; PsychINFO<1980 to December 2012; and Google Scholar<1980 to December 2012. RESULTS We identified 22 papers describing 21 studies comprising 1453 participants, with a mean age of 35.0 years (range of 12-71 years), of whom 68.4% (n=994) were male. Of our sample, 1112 (76.5%) had a diagnosis of schizophrenia. We found small to moderate associations between greater attachment insecurity (as reflected in anxiety and avoidance) and poorer engagement with services, more interpersonal problems, more avoidant coping strategies, more negative appraisals of parenting experiences and more severe trauma. We also found small to modest associations between attachment insecurity and more positive and negative symptoms and greater affective symptom problems. CONCLUSION Attachment theory may be useful as a means of understanding the developmental and interpersonal basis of recovery and adaptation in the context of psychosis. However, further research comprising more representative samples in their first episode and using prospective designs is required.
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Affiliation(s)
- A I Gumley
- University of Glasgow, Glasgow, UK; NHS Greater Glasgow & Clyde, Glasgow, UK
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Hartley S, Barrowclough C, Haddock G. Anxiety and depression in psychosis: a systematic review of associations with positive psychotic symptoms. Acta Psychiatr Scand 2013; 128:327-46. [PMID: 23379898 DOI: 10.1111/acps.12080] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/13/2012] [Accepted: 12/18/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This review explores the influence of anxiety and depression on the experience of positive psychotic symptoms, and investigates the possibility of a causal role for anxiety and depression in the emergence and persistence of psychosis. METHOD A systematic literature search was undertaken, producing a number of papers which comment on the links between anxiety and depression, and the experience of delusions and hallucinations. In addition, evidence which could contribute to our understanding of the causal role of anxiety and depression was highlighted. RESULTS The findings show that both anxiety and depression are associated in meaningful ways with the severity of delusions and hallucinations, the distress they elicit and their content. However, the cross-sectional nature of the majority of studies and the focus on certain symptom subtypes tempers the validity of the findings. Data from non-clinical samples, studies which track the longitudinal course of psychosis and those which examine the impact of anxiety and depression on the prognosis for people experiencing psychosis, offer some support for the possibility of an influential role for anxiety and depression. CONCLUSION We conclude that anxiety and depression are related to psychotic symptom severity, distress and content and are also linked with sub-clinical experiences, symptom development, prognosis and relapse. These links may imply that anxiety and depression could be targets for therapeutic intervention. The article concludes with suggestions for further research, highlighting avenues which may circumvent the limitations of the body of work as it stands.
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Affiliation(s)
- S Hartley
- School of Psychological Sciences, University of Manchester, Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, UK
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