Coping and the stages of psychosis: an investigation into the coping styles in people at risk of psychosis, in people with first-episode and multiple-episode psychoses

Benefits of Hearing Voices Groups & Other Self-Help Groups for Voice Hearers: A Systematic Review

People who hear voices that others do not often rely on mainstream mental health services. Several alternatives to treatment have grown in popularity including "Hearing Voices Groups" and other self-help groups for voice hearers. The aim of this systematic review is to evaluate the current evidence relating to the use of Hearing Voices Groups (HVGs) and other self-help groups for voice hearers, and identify the benefits felt by those attending such groups. The following databases were searched for relevant academic articles: CINAHL; APA PsycArticles; APA PsycInfo; Social Sciences; SocINDEX; UK & Ireland Reference Centre and Medline, with 13 papers identified for inclusion. Participants reported several benefits of attending a HVG/self-help group, which reduced isolation, improved social and coping skills, and gave them a better understanding of the meaning and context of their voices. The groups also provide hope for the future and act as a catalyst for recovery. These study findings suggest that voice hearers find some benefits from attending HVGs/self-help groups. Evidence indicates that voice hearers can live meaningful lives and continue to hear voices once context and meaning to their voices become clear. HVGs/self-help groups provide a vital service to voice hearers, which they felt was not available within mainstream mental health services. If mental health providers gained a better understanding of the HVN, they may be able to integrate the values and ethos of the HVN into groups for voice hearers within mainstream mental health services or signpost voice hearers to these groups.

Personality traits and coping strategies in recent-onset psychosis: Associations with symptom severity and psychosocial functioning

BACKGROUND

Personality and coping may be related to symptom severity and psychosocial functioning in patients with recent-onset psychosis. This study aimed to investigate associations of personality traits and coping strategies with concurrent and follow-up symptom severity and functioning in those patients, and identify whether coping mediates relations between personality and symptoms or functioning.

METHODS

At baseline, 527 recent-onset psychosis patients (73 % male, mean age = 28 years) received assessments on personality (Neuroticism-Extraversion-Openness - Five-Factor Inventory), coping (Utrecht Coping List), symptom severity (Positive And Negative Syndrome Scale) and psychosocial functioning (Global Assessment of Functioning Scale). Of those, 149 also received symptom and functioning assessments at follow-up. Multivariable linear regression analyses were performed to assess cross-sectional associations of personality and coping with symptoms and functioning at baseline. Longitudinal associations of baseline personality and coping with follow-up symptomatic remission and functioning were analyzed with multivariable linear and binary logistic regression analyses, respectively. Lastly, it was investigated whether coping mediated associations between personality and symptoms or functioning.

RESULTS

Higher baseline Agreeableness (B = -0.019, [95%CI: -0.031; -0.007]) and Neuroticism (B = -0.017, [95%CI: -0.028; -0.006]) were associated with lower concurrent symptom severity. Reassuring Thoughts were associated with better functioning at baseline (B = 0.833, [95%CI: 0.272; 1.393]). Neither personality nor coping were associated with follow-up symptomatic remission or functioning. Coping did not mediate associations between personality and symptoms or functioning.

CONCLUSION

Only the coping strategy Reassuring Thoughts is associated with better baseline functioning in patients with recent-onset psychosis. Personality traits seem to have limited clinically relevant relations with symptom severity or functioning.

Heightened risk factors in the midst of the pandemic: Supporting individuals with psychosis during COVID-19

PURPOSE

This article aims to describe distinct vulnerabilities to the psychosocial stress from coronavirus disease 2019 (COVID-19) on individuals with psychosis and provide practical ways to reduce the vulnerabilities.

CONCLUSION

Societal changes and stress have come in the wake of the COVID-19. Individuals with psychosis are more susceptible to stress, cognitive biases, and lack social support. Practitioners working with individuals with psychosis are in a unique position to offer ways to reduce risk.

PRACTICE IMPLICATIONS

Care during the pandemic requires practitioners to pay particular attention to magnified risk factors to individuals with psychosis and create a plan to offer adjunct support.

Training coping skills and coping with stress self-efficacy for successful daily functioning and improved clinical status in patients with psychosis: A randomized controlled pilot study

Due to the symptom diversity and pervasive function impairments (e.g. in perception, cognition, language, affect, behavior, daily and social functioning and sense of self), recurrent relapses, elevated disability, high rates of (co)morbidity, heightened premature mortality and high burden of care of psychotic disorders, psychosocial interventions are part of patients' standard care. There is growing evidence on the relevance of self-efficacy for well-being and functioning among these patients, but specific coping with stress self-efficacy has rarely been investigated. This study explored the outcomes of an intervention for the improvement of coping resources based on training in coping skills and coping with stress self-efficacy. Fourteen adult volunteers with schizophrenia (n = 12) or schizoaffective disorder (n = 2) were matched in clinical and sociodemographic characteristics and randomly assigned to the study groups. The intervention group received the training-with 15 twice per week sessions (8 weeks)-along with their pharmacological therapy; the control group received their prescribed drug therapy. Participants completed self-reports on coping with stress self-efficacy, perceived successful daily functioning based on coping skills and clinical status (Expanded Brief Psychiatric Rating Scale). Trained patients showed a significant increase in coping with stress self-efficacy and reported greater successful functioning status, and significant improvements in their clinical status were also observed. All these enhancements remained at 3-month and 6-month follow-ups. The intervention condition interacted with coping with stress self-efficacy and perceived coping functioning in explaining improvements in clinical status: in the treatment group, greater coping with stress self-efficacy translated into enhanced daily functioning, and this improvement predicted better clinical status. These findings stress the relevance of promoting coping resources in psychotic disorders and provide preliminary evidence for the potential benefits of coping with stress self-efficacy.

Coping Strategies, Anxiety and Depression in OCD and Schizophrenia: Changes during COVID-19

BACKGROUND

The main aim was to examine changes in coping strategies, anxiety and depression in obsessive-compulsive and schizophrenia patients during COVID-19, in addition to controlling the influence of intolerance to uncertainty and experiential avoidance.

METHOD

The first time, the study comprised (15-30 April 2020) 293 patients, 113 of whom were diagnosed with obsessive-compulsive disorder, 61 with schizophrenia and 119 healthy controls, aged 13-77 years (M = 37.89, SD = 12.65). The second time (15-30 November), the study comprised 195 participants (85 obsessive-compulsive patients, 42 schizophrenic patiens and 77 healthy controls participants). The evaluation was carried out through an online survey.

RESULTS

The clinical groups worsened over time in cognitive coping, anxiety and depression, while the control group only worsened in depression. Intergroup differences in anxiety, depression and coping strategies were maintained, highlighting the use of some maladaptive strategies (avoidance, spiritual) in clinical groups. Experiential avoidance and tolerance for uncertainty mainly affected coping.

CONCLUSIONS

The duration of COVID-19 not only produced changes in anxiety and depression in clinical groups but also in coping strategies to face this pandemic and its consequences.

Focusing on quality of life in the family caregivers of patients with schizophrenia from the perspective of family functioning: A cross-sectional study

The study aimed to explore the association between family functioning and quality of life (QOL) in family caregivers of patients with schizophrenia.Totally 121 family caregivers were surveyed in the cross-sectional study by the self-administration questionnaires about sociodemographic characteristics, family functioning and QOL. Family functioning was evaluated in terms of the family assessment device and the Family Adaptability and Cohesion Evaluation Scale II China Version. QOL was evaluated in terms of TSDHE short-form 12-item health survey, version 2. Multiple regression models were built to explore the association between QOL and family functioning.A regression analysis showed that poorer physical health of family caregivers was significantly associated with the lower educational level of caregivers, the closer kinship with patients and the multiple episodes schizophrenia. The other regression analysis showed that better family adaptability and affective responsiveness were significantly associated with the better mental health of family caregivers.Family functioning is associated with mental health rather than the physical health of family caregivers. Psychoeducational intervention could focus on family caregivers with a lower educational level and closer kinship, and those who look after patients with multiple episodes schizophrenia. Further family intervention could focus on family adaptability and affective expression in family caregivers of patients with schizophrenia.

Stress coping strategies and their clinical correlates in patients with psychosis at various stages of illness: A case-control study

AIMS

There is evidence that individuals with psychosis adopt inefficient coping styles. Moreover, it has been hypothesized that inefficient coping styles might serve as trait-dependent characteristics of psychosis. Therefore, we aimed to explore coping styles and their clinical correlates at various stages of psychosis.

METHODS

We recruited 37 individuals at familial high risk of psychosis (FHR-P), 42 individuals with first-episode psychosis (FEP), 28 acutely relapsed schizophrenia (SCZ-AR) subjects and 40 healthy controls. Coping strategies were assessed using the Coping Inventory for Stressful Situations.

RESULTS

Individuals with FEP were less likely to use task-focused coping, while SCZ-AR subjects preferred using distraction when compared to controls. Both groups of participants did not differ significantly in terms of using specific coping styles. No significant differences in the use of various coping strategies between FHR-P individuals and controls were found. Higher odds of using emotion-focused coping and distraction were associated with more severe depressive symptoms in individuals with psychosis. Moreover, higher frequency of using distraction was associated with worse functioning in individuals with psychosis. However, this association appeared to be insignificant after adjustment for multiple testing.

CONCLUSIONS

Coping styles are similar in FEP and SCZ-AR subjects. However, decreased use of task-focused coping is more specific for FEP individuals while a preference of distraction might be more typical for SCZ-AR individuals. The use of various coping styles is similar in FHR-P individuals and controls. Preference of distraction and emotion-focused coping might be related to more severe depressive symptoms and poor functioning in individuals with psychosis.

Coping strategies in first-episode psychosis: A systematic review

AIMS

This paper reviews and discusses the published information on coping strategies in people with a first-episode psychosis (FEP). The objective is to update knowledge about coping strategies used by people with a FEP, to compare these strategies with those used by other mental disorders, and to examine the relationship between coping strategies and other variables in FEP.

METHOD

A search was conducted using PsycINFO, MEDLINE and PSICODOC between 1995 and 2018 using the following terms: coping strategies or Adaptation, Psychological and FEP.

RESULTS

A total of 167 studies were found, of which 14 were selected for review. The results suggest the need for a multiple and integrated approach, since there are several factors that are involved in the coping strategies (eg, socio-demographic, clinical and psychological variables) used in the different profiles of psychotic spectrum, specifically in FEP.

CONCLUSIONS

The role of coping skills is an important issue in psychopathological research in addition to clinical outcome, especially from the point of view of the patients, their social context and their recovery. Moreover, personalized therapies addressed to personal recovery should be considered to develop better coping specifically addressed to patients' needs.

Coping with family stress in individuals at clinical high-risk for psychosis

BACKGROUND

Despite the long-emphasized role of the family environment in the schizophrenia literature, coping with family stress has been neglected in research on the psychosis risk period.

METHODS

The sample consisted of 75 youth at clinical high-risk (CHR) for psychosis and 79 matched healthy controls who reported on their use of engagement and disengagement coping strategies in response to stress with parents and perceived social support (i.e., advice availability, family support and strain). Participants were also assessed for clinical symptoms.

RESULTS

Individuals at CHR reported similar levels of engagement strategies (e.g., emotion regulation, positive thinking) and more frequent use of disengagement strategies (e.g., avoidance, denial) compared to healthy controls. In individuals at CHR (as well as healthy controls), greater use of engagement strategies predicted greater perceptions of availability of advice support, whereas greater employment of disengagement strategies predicted lower perceived social support from the family and greater family strain. In individuals at CHR (as well as healthy controls), engagement strategies were not linked to any clinical outcomes, whereas disengagement strategies were closely tied to anxiety and depression (but not psychosis symptoms in individuals at CHR).

CONCLUSIONS

Individuals at CHR appeared to engage the same amount as controls, but disengage more often when coping with family stress; this pattern was linked to perceptions of social support and tied to a putative family environment as well as clinical phenomenology. The findings have implications for targeting interventions for CHR populations during a vulnerable period for stress and social change.

Allostatic load index and its clinical correlates at various stages of psychosis

Accumulating evidence indicates systemic biological dysregulations in patients with psychosis that have been conceptualized as the "allostatic load" (AL) index. We aimed to investigate the AL index in 37 subjects at familial high risk of psychosis (FHRP), 42 first-episode psychosis (FEP) patients, 25 acutely relapsed schizophrenia (SCZ-AR) patients and 42 healthy controls (HCs), taking into account psychopathology and cognitive impairment. The AL index was calculated based on 15 biomarkers (cardiovascular markers, anthropometric measures, inflammatory markers, glucose homeostasis parameters, lipids and steroids). Cognition was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The AL index was significantly higher in patients with psychosis and FHR-P individuals compared to HCs. Patients with FEP and FHR-P individuals had similar AL index. Moreover, the AL index was significantly higher in SCZ-AR patients compared to other groups of participants. Higher AL index was associated with more severe general psychopathology and depressive symptoms, lower scores of attention (total score, digit span and digit coding tasks) and semantic fluency, as well as worse general functioning in patients with psychosis. There was a significant negative correlation between the AL index and the scores of attention (total score and digit coding task) in FHR-P individuals. No significant correlations between the AL index and cognition were found in HCs. Our results indicate that biological dysregulations, captured by the AL index, appear already in FHR-P individuals and progress with psychotic exacerbations. Elevated AL index might contribute to cognitive impairments in FHR-P individuals and patients with psychosis.

The association between specific types of childhood adversity and attenuated psychotic symptoms in a community sample

AIM

This study aimed to examine the relationship between types of childhood adversity and attenuated psychotic symptoms in a general population sample, and to determine the predictive role of other psychosocial factors such as resilience, coping style and social support.

METHODS

An online survey was conducted with a US-based general population sample of 748 participants (aged 18 to 35 years) using Amazon's Mechanical Turk (an online crowd-sourcing service). Participants completed the Adverse Childhood Experiences Questionnaire (ACE-Q), the Prodromal Questionnaire (PQ-16), the Brief COPE Scale, the Brief Resilience Scale (BRS), the Multidimensional Scale of Perceived Social Support and the Neighbourhood Cohesion Scale. A series of backwards stepwise hierarchical regression analyses was employed to determine the predictors of PQ-16 score.

RESULTS

Participants reported an average of 2.99 attenuated psychotic symptoms (from a total of 16), and an average of 2.77 childhood adversities (from a total of 10). In the final model, the specific types of childhood adversity which significantly predicted PQ-16 score were verbal abuse, sexual abuse and physical neglect. Resilience, as well as the coping styles of self-distraction, denial, substance use, emotional support, venting, religion and self-blame, were significant predictors; perceived social support and neighbourhood cohesion were not. This model predicted 33% of the variance in PQ-16 score.

CONCLUSIONS

The results of this study support the association between childhood adversity and attenuated psychotic symptoms in the general population. Resilience and coping styles were also important predictive factors. These data suggest potential strategies on which to focus for early intervention and prevention.

Coping styles and symptomatic manifestation of first-episode psychosis: Focus on cognitive performance

Cognitive deficits are widely observed in patients with psychosis and represent one of most important determinants of functional outcomes. It has been shown that patients with psychosis prefer maladaptive coping strategies over active coping styles. However, it remains unknown whether cognitive impairments are related to coping styles in psychotic disorders. Therefore, the aim of this study was to assess whether cognitive deficits observed in patients with first-episode psychosis (FEP) might impact the use of specific coping strategies. We recruited 40 FEP patients and 35 healthy controls. In our study, FEP patients were more likely to use maladaptive coping styles after adjustment for education level and medication effects. The use of maladaptive coping strategies was associated with greater impairments of visuospatial/constructional abilities and language skills in FEP patients. In addition, lower odds of using adaptive coping were related to higher levels of depressive symptoms in the group of patients. Adaptive coping was associated with better global cognitive performance in healthy controls. Our results indicate that cognitive impairments, especially worse performance of visuospatial/constructional abilities and language skills, might be related to the preference of maladaptive coping strategies. Lower odds of using adaptive coping styles might be associated with more severe depressive symptomatology.

Coping strategies in individuals at ultra-high risk of psychosis: A systematic review

AIM

The impact of dysfunctional coping strategies during the prodromal phase of psychosis has recently been explored by several studies. What has yet to be clarified is whether maladaptive coping is evident in the prodromal phase and the impact that this might have on symptomatic and functional outcomes. The aim of this study was to review the findings on coping in individuals at ultra-high risk of psychosis (UHR) in relation to symptoms and level of functioning.

METHODS

Original articles were identified by searching 7 databases using the terms "prodrom*," "ultra high risk," "clinical high risk," "at-risk mental state," "coping style*," "coping strategies," "cope," "coping" and "psychosis". We included original articles that: (1) reported a measure of coping and (2) evaluated UHR individuals.

RESULTS

A total of 9 original articles of 335 that examined coping in individuals at high risk of psychosis were included. UHR subjects were more likely to use maladaptive coping strategies than healthy controls and were more likely to use emotion-focussed than task-oriented coping. Maladaptive coping was associated with higher levels of negative symptoms, whereas positive coping was associated with fewer negative symptoms. The coping style employed by UHR individuals was found to negatively influence their psychosocial functioning.

CONCLUSIONS

It is still unclear whether coping heightens or reduces the likelihood of transition to psychosis in relation to other factors, including environment. Longitudinal studies could clarify whether coping styles remain stable after the onset of psychosis or whether the emerging psychotic symptoms influence the coping strategies.

A mental health home visit service partnership intervention on improving patients' satisfaction

AIMS

To investigate a partnership intervention of the community-based and hospital-based home visit to improve patients' satisfaction.

METHODS

A time series quasi-experimental quantitative design was used. The experimental group had "partnership intervention", while the control group maintained routine home visits. Patient satisfaction was measured pre-intervention, six months and 12 months after the partnership intervention.

RESULTS

Six and 12 months after partnership intervention, in the experimental group, items related to stabilizing disease conditions, improving daily living abilities, enhancing communication ability and providing relevant resources were significantly higher than pre-intervention. However, 12 months after the intervention, the influence of the intervention became weaken.

CONCLUSIONS

The partnership intervention can significantly improve patients' satisfaction with home visit service.

Vulnerability, Stress, and Support in the Disease Trajectory from Prodrome to Diagnosed Schizophrenia: Diathesis-Stress-Support Model

Schizophrenia is a debilitating psychiatric disorder seen across the world. The goal of current research is to provide a more comprehensive understanding of prodrome, the initial period before the disease manifests as schizophrenia. Unfortunately, there is little information to comprehensively understand the indicators that later lead to schizophrenia. This has resulted in a lack of scientific knowledge to aid in early identification and intervention by psychiatric nurses or school nurses. Such information could inform nursing assessment and care plan development. The purpose of this paper is to construct a conceptual model for describing the important factors relating to the schizophrenia prodrome process in human developmental manner by critically synthesizing empirical evidence and reviewing the strengths and limitations of current conceptual models.

Coping strategies and quality of life in schizophrenia: cross-sectional study

BACKGROUND

The modern psychiatric view of schizophrenia spectrum disorders and their treatment has led to an increasing focus on coping strategies and the quality of life of these patients. In the present study, the authors examined the relationship between demographic data, the severity of symptoms, coping strategies, and the quality of life in psychotic patients. It is important to study the inner experience and striving of these individuals as it has been linked to their well-being and treatment adherence.

METHODS

Psychiatric outpatients who met International Classification of Diseases, Tenth Revision criteria for a psychotic disorder (schizophrenia, schizoaffective disorder, or delusional disorder) were recruited in the study. Questionnaires measuring the coping strategies (The Stress Coping Style Questionnaire [SVF-78]), the quality of life (Quality of Life Satisfaction and Enjoyment Questionnaire [Q-LES-Q]), and symptom severity (objective and subjective Clinical Global Impression - objCGI; subjCGI) were assessed. The data were analyzed using one-way analysis of variance, Mann-Whitney U test, Pearson and Spearman correlation coefficients, and multiple regression analysis.

RESULTS

A total of 109 psychotic patients were included in the study. The quality of life was significantly related to both the positive and negative coping strategies. The severity of disorder was highly negatively correlated with the quality of life score. The results of multiple stepwise regression analysis using the quality of life as a dependent variable showed that symptom severity (subjCGI, difference between subjCGI, and objCGI), negative coping strategies, positive coping strategies, and the difference between positive and negative coping strategies explain more than half variance.

CONCLUSION

Our study suggests the importance of utilizing the positive coping strategies in improving the quality of life in patients with psychotic disorders.