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Arnold SRC, Huang Y, Lawson LP, Higgins JM, Hwang YI(J, Richdale A, Trollor JN. Development of the Impact of Diagnosis Scale-Revised (IODS-R). Assessment 2024; 31:908-919. [PMID: 37700577 PMCID: PMC11092292 DOI: 10.1177/10731911231196486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
No tools quantify the experience, psychological, and practical impact of receiving a diagnosis from a non-deficit perspective. Autism is increasingly late diagnosed in adulthood. The Impact of Diagnosis Scale (IODS) was initially developed for borderline personality disorder. We aimed to develop a revised version suitable for autistic adults and potentially other diagnostic groups. Following a trial of a preliminary revision, the researchers and autistic research advisors co-produced an expanded pool of 46 items, scored on 7-point Likert-type scale, within 6 hypothesized domains. Scale reduction processes were applied to data from 125 formally diagnosed autistic adults. Following iterative rounds of factor analysis using maximum likelihood estimation with Promax rotation, 22 items were retained across 4 domains to comprise the IODS-R. The IODS-R adds new understanding to the experience of receiving an autism diagnosis in adulthood. It may be useful for evaluating diagnostic services and other diagnostic groups.
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Affiliation(s)
- Samuel R. C. Arnold
- School of Psychology, Western Sydney University, Bankstown, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Yunhe Huang
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Lauren P. Lawson
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Julianne M. Higgins
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Ye In (Jane) Hwang
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- School of Population Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, Australia
| | - Amanda Richdale
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Julian N. Trollor
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
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Swistak MSc Z, Sookoo Ma S, Jewell PhD T. Integrating Subjective Recovery and Stigma Resistance in Individuals with Schizophrenia: A Narrative Review and Theoretical Integration. Issues Ment Health Nurs 2024; 45:537-551. [PMID: 38684074 DOI: 10.1080/01612840.2024.2341049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Stigmatised attitudes are known to be associated with negative outcomes in schizophrenia, yet there is little focus on the role of stigma in the recovery process. Attempts to develop interventions to reduce self-stigma in schizophrenia have not been found effective. This paper presents a theoretical integration based on a narrative review of the literature. PsycINFO, Medline and Embase databases were searched up to the 11th December 2023. Studies were included if they were: i) empirical studies using qualitative, quantitative or mixed methods studies investigating mental health stigma; ii) included participants based in the United Kingdom, fluent in English, between the ages of 16 and 70, meeting criteria for a schizophrenia spectrum diagnosis. Fourteen studies were included. In Part 1, we propose a novel theoretical model derived from a synthesis of service-user perspectives on the relationship between stigma and schizophrenia. Stigmatised attitudes were commonly perceived to be caused by a lack of education and further exacerbated by disinformation primarily through the media and cultural communities. Stigma led to negative self-perceptions, negative emotional responses, social isolation and increased symptom severity, ultimately acting as a barrier to recovery. In Part 2, we identify several factors that ameliorate the impact of stigma and promote clinical and subjective recovery among service-users: education, empowerment, self-efficacy, self-acceptance, hope and social support. We argue that the notion of stigma resistance may be helpful in developing new interventions aimed at promoting recovery in individuals with schizophrenia. Wider implications are discussed and recommendations for future research and practice are explored.
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Affiliation(s)
- Zosia Swistak MSc
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
- The Nightingale Hospital, London, UK
| | - Susan Sookoo Ma
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Tom Jewell PhD
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Fulton-Hamilton E, Morgan G. Examining Attitudes Towards Mental Health Diagnoses: A Q-Methodology Study. J Ment Health 2024; 33:57-65. [PMID: 37129104 DOI: 10.1080/09638237.2023.2182430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/07/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Debates exist regarding the validity and utility of functional psychiatric diagnoses. How mental health diagnoses are understood has real impacts for service users and service delivery. AIMS To investigate different attitudes about the utility of psychiatric diagnoses. METHODS Forty-one stakeholders sorted 57 statements related to the usefulness of psychiatric diagnoses. Using q-methodology, four viewpoints were identified and interpreted. RESULTS Viewpoint 1 (Pathologising human experience) regarded diagnoses as pseudo-scientific constructs that lacked validity and obscured the relationships between lived experience and distress. Viewpoint 2 (Illnesses like any other) held that labels reflected real disorders and diagnosis offered important benefits for service users and services. Viewpoint 3 (Stigmatised conditions) similarly regarded diagnoses as reflecting real disorders, but diagnostic criteria were viewed as biased and the impacts of applying labels seen as causing problems for service users. Conversely, Viewpoint 4 (Useful short-hands) viewed diagnostic processes as imperfect but necessary for supporting communication and structuring service delivery. CONCLUSIONS While not all viewpoints are in keeping with empirical evidence, we hope results will enable professionals and service users to take meta-positions in relation to their own and others' attitudes, and to reflect on the impacts of privileging certain viewpoints over others.
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Affiliation(s)
- Emily Fulton-Hamilton
- School of Psychology, George Davies Centre, University of Leicester, Leicester, England
| | - Gareth Morgan
- School of Psychology, George Davies Centre, University of Leicester, Leicester, England
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Villena-Jimena A, Morales-Asencio JM, Quemada C, Hurtado MM. "It's That They Treated Me Like an Object": A Qualitative Study on the Participation of People Diagnosed with Psychotic Disorders in Their Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4614. [PMID: 36901624 PMCID: PMC10002244 DOI: 10.3390/ijerph20054614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
The mental health recovery model is based on shared decision making, in which patients' preferences and perceptions of the care received are taken into account. However, persons with psychosis usually have very few opportunities to participate in this process. The present study explores the experiences and perceptions of a group of patients with psychosis-in some cases longstanding, in others more recently diagnosed-concerning their participation in the decisions taken about the approach to their condition and about the attention received from healthcare professionals and services. For this purpose, we performed a qualitative analysis of the outcomes derived from five focus groups and six in-depth interviews (36 participants). Two major themes, with five sub-themes, were identified: shared decision-making (drug-centred approach, negotiation process, and lack of information) and the care environment and styles of clinical practice as determinants (aggressive versus person-centred environments, and styles of professional practice). The main conclusions drawn are that users want to participate more in decision making, they want to be offered a range of psychosocial options from the outset and that their treatment should be based on accessibility, humanity and respect. These findings are in line with the guidelines for clinical practice and should be taken into account in the design of care programmes and the organisation of services for persons with psychosis.
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Affiliation(s)
- Amelia Villena-Jimena
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - José Miguel Morales-Asencio
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - Casta Quemada
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - María M. Hurtado
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
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Viduani A, Benetti S, Petresco S, Piccin J, Velazquez B, Fisher HL, Mondelli V, Kohrt BA, Kieling C. The experience of receiving a diagnosis of depression in adolescence: A pilot qualitative study in Brazil. Clin Child Psychol Psychiatry 2022; 27:598-612. [PMID: 35156863 PMCID: PMC7612913 DOI: 10.1177/13591045211063494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Receiving a diagnosis of depression can have an important impact on the lives of adolescents. However, there is limited information about how youth tackle, attribute meaning to and understand mental health diagnoses. The aim of this study was to explore adolescents' initial reactions after receiving a clinical diagnosis of Major Depressive Disorder in the context of a neurobiological study of depression in Brazil. Using a qualitative design, eight Brazilian adolescents were interviewed twice: immediately after a psychiatric assessment and neuroimaging study, in which they were given a diagnosis of depression, and in a follow-up visit 2 weeks later. Interviews were designed to explore the subjective experience of receiving the diagnosis and the impacts of depression on adolescents' lives. Framework Analysis was used to analyze the accounts. Diagnosis was perceived as a reification of an abnormal status, highlighting the role of stigma and the process of disclosing the diagnosis to others. Adolescents reported the multiple sensemaking processes that occurred when they received a diagnosis of depression, and most struggled with the idea that negative emotions would equate their experience with a disorder. The results show that future efforts could enhance clinical assessment processes with adolescents by exploring adolescents' reactions to diagnosis, as well as the support networks available to them, resulting in increased help-seeking behaviors, and diminished social and personal stigma.
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Affiliation(s)
- Anna Viduani
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Silvia Benetti
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sandra Petresco
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jader Piccin
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruna Velazquez
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, 4616King's College London, UK.,ESRC Centre for Society and Mental Health, 4616King's College London, UK
| | - Valeria Mondelli
- Department of Psychological Medicine, 34426King's College London Institute of Psychiatry Psychology & Neuroscience, UK
| | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, DC, USA
| | - Christian Kieling
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil
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Recovery priorities of people with psychosis in acute mental health in-patient settings: a Q-methodology study. Behav Cogn Psychother 2021; 50:1-14. [PMID: 33551016 DOI: 10.1017/s1352465820000892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Personal recovery from psychosis has been explored extensively in community samples but there has been little exploration with people currently receiving care from an acute mental health in-patient setting. AIMS The aim of this study was to explore the personal recovery priorities of people experiencing psychosis who are currently receiving care from an acute mental health in-patient ward. METHOD A Q-methodology mixed-methods approach was adopted. Thirty-eight participants were recruited from an outer London acute mental health hospital. They were required to sort 54 statements regarding personal recovery from most important to least important to reflect their recovery priorities. Thirty-six were included in the final analysis. RESULTS Analysis revealed four distinct viewpoints relating to factors that promote recovery in the acute mental health in-patient setting. These were: stability, independence and 'keeping a roof over your head'; hope, optimism and enhancing well-being; personal change, self-management and social support; and symptom reduction through mental health support. CONCLUSIONS Acute mental health in-patient wards need to ensure that they are considering the personal recovery needs of in-patients. Symptom reduction was valued by some, but broad psychosocial factors were also of priority.
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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.
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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
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Pallesen K, Brown J, Rose D, Lawrence V. An interpretative phenomenological analysis of the experience of receiving a diagnosis of bi-polar disorder. J Ment Health 2020; 29:358-363. [PMID: 32326856 DOI: 10.1080/09638237.2020.1755020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Research has shown that receiving a psychiatric diagnosis can have both positive and negative consequences for people. The way in which diagnoses are imparted is an under-researched area and may play an important role in reducing stigma and aiding recovery.Aims: The aim of the present study was to get an in-depth understanding of service users' experience of receiving a diagnosis of bipolar disorder.Methods: Nine service users recently diagnosed with bipolar disorder were interviewed using a semi-structured interview schedule designed to elicit information regarding the positive and negative aspects of receiving their diagnosis. All transcripts were analysed using Interpretative Phenomenological Analysis (IPA).Findings: The findings can be described in terms of three master themes: 1. "Perceived fit between diagnosis and lived experience", 2. "Evaluating the utility of carrying the diagnostic label" and 3. "The role of diagnosis in searching for solutions to one's difficulties".Conclusion: This study draws attention to the importance of evaluating the fit between diagnosis and personal experiences and to the relevance of perceived stigma. The findings also highlight the significance of the client-clinician relationship in establishing fit and instilling hope, which has implications for the acceptance of the diagnosis and engagement with services.
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Affiliation(s)
- Kasper Pallesen
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - June Brown
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - Diana Rose
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - Vanessa Lawrence
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
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Hackmann C, Balhara YPS, Clayman K, Nemec PB, Notley C, Pike K, Reed GM, Sharan P, Rana MS, Silver J, Swarbrick M, Wilson J, Zeilig H, Shakespeare T. Perspectives on ICD-11 to understand and improve mental health diagnosis using expertise by experience (INCLUDE Study): an international qualitative study. Lancet Psychiatry 2019; 6:778-785. [PMID: 31296444 DOI: 10.1016/s2215-0366(19)30093-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 12/16/2022]
Abstract
Developed in collaboration with WHO Department of Mental Health and Substance Abuse, this study (conducted in India, the UK, and the USA) integrated feedback from mental health service users into the development of the chapter on mental, behavioural, and neurodevelopmental disorders for ICD-11. The ICD-11 will be used for health reporting from January, 2022. As a reporting standard and diagnostic classification system, ICD-11 will be highly influential by informing policy, clinical practice, and research that affect mental health service users. We report here the first study to systematically seek and collate service user perspectives on a major classification and diagnostic guideline. Focus groups were used to collect feedback on five diagnoses: depressive episode, generalised anxiety disorder, schizophrenia, bipolar type 1 disorder, and personality disorder. Participants were given the official draft diagnostic guidelines and a parallel lay translation. Data were then thematically analysed, forming the basis of co-produced recommendations for WHO, which included features that could be added or revised to better reflect lived experience and changes to language that was confusing or objectionable to service users. The findings indicated that an accessible lay language version of the ICD-11 could be beneficial for service users and their supporters.
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Affiliation(s)
- Corinna Hackmann
- Department of Research and Development, Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| | - Kelsey Clayman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Kathleen Pike
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| | - Mona Sharma Rana
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| | - Jody Silver
- Collaborative Support Programs of New Jersey, Freehold, NJ, USA
| | - Margaret Swarbrick
- Collaborative Support Programs of New Jersey, Freehold, NJ, USA; Practice Innovation and Wellness, Rutgers Health University, Behavioral Health Care, Piscataway, NJ, USA
| | - Jon Wilson
- Department of Research and Development, Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Hannah Zeilig
- London College of Fashion, University of the Arts London, London, UK
| | - Tom Shakespeare
- Infectious and Tropical Diseases Department, International Centre for Evidence in Disability, London School of Health and Tropical Hygiene, Keppel Street, London, UK
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Bakker GM. A new conception and subsequent taxonomy of clinical psychological problems. BMC Psychol 2019; 7:46. [PMID: 31291999 PMCID: PMC6617608 DOI: 10.1186/s40359-019-0318-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A taxonomy of the objects of study, theory, assessment, and intervention is critical to the development of all clinical sciences. Clinical psychology has been conceptually and administratively dominated by the taxonomy of an adjacent discipline - psychiatry's Diagnostic and statistical manual of mental disorders (DSM). Many have called for a 'paradigm shift' away from a medical nosology of diseases toward clinical psychology's own taxonomy of clinical psychological problems (CPPs), without being able to specify what is to be listed and classified. MAIN TEXT An examination of DSM's problems for clinical psychology, especially its lack of clinical utility, and a search for the essence of CPPs in what clinical psychologists actually do, leads to the proposal that: The critical psychological-level phenomenon underlying CPPs is the occurrence of 'problem-maintaining circles' (PMCs) of causally related cognitions, emotions, behaviours, and/or stimuli. This concept provides an empirically-derived, theory-based, treatment-relevant, categorical, essentialist, parsimonious, and nonstigmatizing definition of CPPs. It distinguishes psychological problems in which PMCs have not (yet?) formed, and which may respond to 'counseling', clinical psychological problems in which active PMCs require clinical intervention, and psychopathological problems which are unlikely to be 'cured' by PMC-breaking alone. CONCLUSION A subsequent classification and coding system of PMCs is proposed, and expected benefits to research, communication, and the quality of case formulation in clinical psychology are described, reliant upon a development effort of some meaningful fraction of that which has been devoted to the DSM.
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Affiliation(s)
- Gary M Bakker
- School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tasmania, 7250, Australia.
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11
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Hackmann C, Wilson J, Perkins A, Zeilig H. Collaborative diagnosis between clinician and patient: why to do it and what to consider. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThis article discusses findings from the literature and our own research related to the experience of the diagnostic process in mental healthcare, primarily from the perspective of patients, and it focuses on the benefits of collaboration. A common finding throughout our research is that, if a diagnostic process is undertaken, the majority of patients want to be actively involved and feel valued in it. This helps ensure that they find the process and the resulting diagnosis to be meaningful, informative and useful. We believe that collaboration could also mitigate some of the reported negative unintended consequences of diagnosis, including feeling stigmatised, labelled and disempowered. Our work has led us to conceive of diagnosis as having two overarching elements: the diagnostic process and the resulting diagnostic label. This article focuses specifically on the diagnostic process; we do not consider here the debate surrounding the evidence base for the validity of psychiatric classification.LEARNING OBJECTIVESAfter reading this article you will be able to:
•understand patients' experiences of the diagnostic process•achieve a shared and collaborative diagnostic process with patients•reflect on potential barriers and facilitators to collaborative diagnosis in your own practice.DECLARATION OF INTERESTNone.
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Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings. Lancet Psychiatry 2018; 5:747-764. [PMID: 29680468 DOI: 10.1016/s2215-0366(18)30095-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/23/2022]
Abstract
Receiving a mental health diagnosis can be pivotal for service users, and it has been described in both positive and negative terms. What influences service-user experience of the diagnostic process is unclear; consequently, clinicians report uncertainty regarding best practice. This Review aims to understand and inform diagnostic practice through a comprehensive synthesis of qualitative data on views and experiences from key stakeholders (service users, clinicians, carers, and family). We searched five databases and identified 78 papers for inclusion, originating from 13 countries and including 2228 participants. Eligible papers were assessed for quality, and data were coded and then developed into themes, which generated a model representing factors to consider for clinicians conveying, and individuals receiving, mental health diagnoses. Themes included disclosure, information provision, collaboration, timing, stigma, and functional value of diagnosis for recovery. Variations between different stakeholders and clinical contexts are explored. Findings support an individualised, collaborative, and holistic approach to mental health diagnosis.
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Ottewell N. A qualitative study of illness identity: schizophrenia and depression. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2018. [DOI: 10.4081/qrmh.2018.7420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Illness identity refers to the interpretation of having mental illness in persons who regard themselves as mentally ill. Illness identity can impact people diagnosed with mental illness negatively. However, little is known about the background of illness identity. This study aimed to investigate the process whereby mental health service users accept their diagnosis and develop an illness identity and to compare the processes between schizophrenia and depression. Twenty persons with schizophrenia and depression were interviewed, and the data were analysed using grounded theory approach. The major findings were as follows: i) while those with schizophrenia were shocked by their diagnosis and took time to accept it, this was not true for those with depression; ii) for participants with depression, it was relatively easy to accept their diagnosis, as they thought that depression was a normal illness; participants with schizophrenia needed to learn about their illness, know the efficacy of psychiatric medication and reduce their prejudice against mental illness to accept their diagnosis; and iii) participants’ illness identity encompassed sickness and normality with sickness being related to taking psychiatric medication and normality being associated with having regular work, acting as other people do or living in the community. These findings suggest the influence of social attitudes to each illness on illness identity and the complex nature of illness identity.
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Wood L, Price J, Morrison A, Haddock G. Conceptualisation of recovery from psychosis: a service-user
perspective. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.109.027409] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodThere has been much uncertainty about the concept of recovery in
psychosis. The aim of this paper is to conceptualise recovery, through
service users' descriptions of their recovery stories. A qualitative
approach (interpretive phenomenological analysis) was used to guide
interviews and analysis of data.ResultsEight service users were interviewed about their recovery from psychosis.
Data analysis revealed four superordinate themes: ‘impacts on mental
health’, ‘self-change and adaptation’, ‘social redefinition’ and
‘individualised coping mechanisms’.Clinical implicationsData indicates that multiple dimensions of recovery are all important to
individuals when considering their subjective experiences of recovery
from psychosis. Recovery can only be conceptualised by the person making
the recovery journey and treatment outcome measures must reflect this
individuality.
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Pyle M, Morrison AP. Internalised stereotypes across ultra-high risk of psychosis and psychosis populations. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1295097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Melissa Pyle
- The Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Department of Psychology, The University of Manchester, Manchester, UK
| | - Anthony P. Morrison
- The Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Department of Psychology, The University of Manchester, Manchester, UK
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Abstract
Background:Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory.Aims:The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis.Method:Previous literature is reviewed, critiqued and synthesized to develop the model. It draws upon previous social cognitive models of internalized stigma and integrates cognitive behavioural theory and social mentality theory.Results:This paper identifies key cognitive, behavioural and emotional processes that contribute to the development and maintenance of internalized stigma, whilst also recognizing the central importance of cultural context in creating negative stereotypes of psychosis. Moreover, therapeutic strategies to alleviate internalized stigma are identified. A case example is explored and a formulation and brief intervention plan was developed in order to illustrate the model in practice.Conclusion:An integrative cognitive model is presented, which can be used to develop individualized case formulations, which can guide cognitive behavioural interventions targeting internalized stigma in those who experience psychosis. More research is required to examine the efficacy of such interventions. In addition, it is imperative to continue to research interventions that create change in stigma at a societal level.
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17
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Ottewell N. Stigma against mental illness: Perspectives of mental health service users. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.mhp.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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18
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Morrison AP, Law H, Barrowclough C, Bentall RP, Haddock G, Jones SH, Kilbride M, Pitt E, Shryane N, Tarrier N, Welford M, Dunn G. Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Heather Law
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Richard P Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Gillian Haddock
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Steven H Jones
- The Spectrum Centre for Mental Health Research, University of Lancaster, Lancaster, UK
| | - Martina Kilbride
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Elizabeth Pitt
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Nicholas Shryane
- School of Social Sciences, University of Manchester, Manchester, UK
| | - Nicholas Tarrier
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Mary Welford
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
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Lawrie SM, O'Donovan MC, Saks E, Burns T, Lieberman JA. Improving classification of psychoses. Lancet Psychiatry 2016; 3:367-74. [PMID: 27063387 DOI: 10.1016/s2215-0366(15)00577-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 12/06/2015] [Accepted: 12/14/2015] [Indexed: 12/30/2022]
Abstract
Psychosis has been recognised as an abnormal state in need of care throughout history and by diverse cultures. Present classifications of psychotic disorder remain based on the presence of specific psychotic symptoms, relative to affective and other symptoms, and their sequence and duration. Although extant diagnostic classifications have restricted validity, they have proven reliability and most clinicians and some patients find them useful. Moreover, these classifications have yet to be replaced by anything better. We propose that an expansion of the subgrouping approach inherent to classification will provide incremental improvement to present diagnostic constructs-as has worked in the rest of medicine. We also propose that subgroups could be created both within and across present diagnostic classifications, taking into consideration the potential value of continuous measures (eg, duration of psychotic symptoms and intelligence quotient). Health-care workers also need to work with service users and carers to develop and adapt approaches to diagnosis that are seen as helpful.
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Affiliation(s)
- Stephen M Lawrie
- Department of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, UK.
| | - Michael C O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Elyn Saks
- USC Gould School of Law, University of Southern California, Los Angela, CA, USA
| | - Tom Burns
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jeffrey A Lieberman
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
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Mora-Rios J, Ortega-Ortega M, Natera G. Subjective Experience and Resources for Coping With Stigma in People With a Diagnosis of Schizophrenia: An Intersectional Approach. QUALITATIVE HEALTH RESEARCH 2016; 26:697-711. [PMID: 25670665 DOI: 10.1177/1049732315570118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this study, we investigate the subjective experience of a group of individuals, diagnosed with schizophrenia, undergoing outpatient treatment in four psychiatric clinics in Mexico City. Our objective is to use the paradigm of intersectionality to explore the most common forms of stigma and discrimination faced by people with this illness, as well as the coping resources they employ. The major contribution of this study is its use of in-depth interviews and thematic analysis of the information obtained to identify the importance of sociocultural aspects of participants' experience of their illness. Schizophrenia, for them, was a problem of "nerves," whose origins were linked to magical or religious elements they attributed to their illness and which influenced their response to it. This resignification was useful to participants as a coping resource; it helped them find meaning and significance in their experience of the illness.
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Affiliation(s)
- Jazmín Mora-Rios
- National Institute of Psychiatry, Dr. Ramón de la Fuente Muñiz, Tlalpan, Mexico
| | - Miriam Ortega-Ortega
- Master Program in Health Sciences, National Autonomous University of Mexico. Mexico
| | - Guillermina Natera
- National Institute of Psychiatry, Dr. Ramón de la Fuente Muñiz, Tlalpan, Mexico
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21
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Loughland C, Cheng K, Harris G, Kelly B, Cohen M, Sandhu H, Varmos M, Levin TT, Bylund C, Landa Y, Outram S. Communication of a schizophrenia diagnosis: A qualitative study of patients' perspectives. Int J Soc Psychiatry 2015; 61:729-34. [PMID: 25834281 DOI: 10.1177/0020764015576814] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transparent diagnostic communication is considered best practice for clinicians. However, while patients expect to receive a schizophrenia diagnosis from their psychiatrist, research suggests mental health clinicians are often reluctant to provide this information to patients. AIM This study examines the perceptions of people with schizophrenia surrounding the communication of this diagnosis. METHODS A generic qualitative methodological approach was used. A total of 14 patients with schizophrenia were recruited through community mental health services (n = 10) and the Australia Schizophrenia Research Bank (ASRB; n = 4) in New South Wales (NSW), Australia. Semi-structured interviews were used to explore the experiences and perceptions of people with schizophrenia about the way a schizophrenia diagnosis was communicated by mental health clinicians. Interviews were recorded, transcribed, codes generated and thematic analysis undertaken aided by NVivo. RESULTS The majority of participants felt it was beneficial to receive a diagnosis despite acknowledging the distress this information sometimes caused, with many reporting this knowledge gave a sense of relief. It helped to understand their experiences and behaviours, improved their trust in the psychiatric system and increased treatment adherence. However, many reported difficulty in obtaining information about their condition, its treatment and prognosis, and expressed dissatisfaction with the way a diagnosis of schizophrenia was communicated. DISCUSSION Insight into the perceptions and experiences of patients with schizophrenia about how a diagnosis of schizophrenia is communicated is a key outcome of this research. This knowledge will inform the development of future training programmes for mental health clinicians, and influence the clinical practice of health professionals treating patients with schizophrenia.
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Affiliation(s)
- Carmel Loughland
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia and Hunter Medical Research Institute Australian Schizophrenia Research Bank (ASRB), Schizophrenia Research Institute (SRI), Sydney, NSW, Australia Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Kylie Cheng
- Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Gillian Harris
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia and Hunter Medical Research Institute Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Brian Kelly
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia and Hunter Medical Research Institute Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Martin Cohen
- Hunter New England Mental Health, Newcastle, NSW, Australia
| | | | - Marina Varmos
- Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Tomer T Levin
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Carma Bylund
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Yulia Landa
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Sue Outram
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia and Hunter Medical Research Institute
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Lam DCK, Salkovskis PM, Hogg LI. ‘Judging a book by its cover’: An experimental study of the negative impact of a diagnosis of borderline personality disorder on clinicians’ judgements of uncomplicated panic disorder. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2015. [DOI: 10.1111/bjc.12093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Danny C. K. Lam
- Kingston University & St George's Hospital Medical School; London UK
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Avdi E, Lerou V, Seikkula J. Dialogical Features, Therapist Responsiveness, and Agency in a Therapy for Psychosis. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2015. [DOI: 10.1080/10720537.2014.994692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Howe L, Tickle A, Brown I. 'Schizophrenia is a dirty word': service users' experiences of receiving a diagnosis of schizophrenia. PSYCHIATRIC BULLETIN 2014; 38:154-8. [PMID: 25237536 PMCID: PMC4115437 DOI: 10.1192/pb.bp.113.045179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/18/2013] [Accepted: 11/15/2013] [Indexed: 11/23/2022]
Abstract
Aims and method To explore service users’ experiences of receiving a diagnosis of schizophrenia and the stigma associated with the diagnostic label. Seven participants were interviewed about their perceptions of these experiences. Interviews were analysed using interpretative phenomenological analysis. Results Five superordinate themes resulted from the analysis: (1) avoidance of the diagnosis of schizophrenia; (2) stigma and diagnostic labels; (3) lack of understanding of schizophrenia; (4) managing stigma to maintain normality; (5) being ‘schizophrenic’. These, together with their subthemes, highlighted avoidance of the term schizophrenia by participants and use of alternative terms by professionals, which limited opportunities for understanding the label and challenging associated stigma. Participants strived to maintain normality despite potential stigma. Clinical implications There is a need to address the process of giving a diagnosis as a phenomenon of consequence within its own terms. Implications relate to how professionals deliver and discuss the diagnosis of schizophrenia.
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Affiliation(s)
| | - Anna Tickle
- Nottingham University, UK ; Nottinghamshire Healthcare NHS Trust, UK
| | - Ian Brown
- Nottinghamshire Healthcare NHS Trust, UK
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McGrath L, Peters S, Wieck A, Wittkowski A. The process of recovery in women who experienced psychosis following childbirth. BMC Psychiatry 2013; 13:341. [PMID: 24359103 PMCID: PMC3882497 DOI: 10.1186/1471-244x-13-341] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 11/11/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Psychosis following childbirth affects 1-2 mothers per 1000 deliveries. Onset is rapid and functioning is severely affected. Although prognosis in terms of symptom remission is generally good, long-term disability can persist. The study's aim was to develop a theoretical understanding of recovery from psychosis following childbirth. METHODS Semi-structured interviews were conducted with 12 women with experience of psychosis following childbirth. Interview transcripts were analysed using grounded theory methodology. RESULTS A theory of four superordinate themes was developed from the data, including: (i) the process of recovery; (ii) evolving an understanding; (iii) strategies for recovery; and (iv) sociocultural context. The process of recovery and women's understanding of their experience were conceptualised as parallel processes, which informed one another. Women found that a diagnosis facilitated their use of particular strategies. CONCLUSIONS This study highlighted a complex and ongoing process of recovery from psychosis following childbirth. Sensitivity to a woman's position in the process of recovery has the potential to facilitate professionals in assessing readiness for different interventions which will be likely to result in women feeling more understood, accepted and supported.
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Affiliation(s)
- Laura McGrath
- School of Psychological Sciences, the University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
| | - Sarah Peters
- School of Psychological Sciences, the University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
| | - Angelika Wieck
- Manchester Mental Health and Social Care Trust, Wythenshawe Hospital, Manchester, UK
| | - Anja Wittkowski
- School of Psychological Sciences, the University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
- Manchester Mental Health and Social Care Trust, Wythenshawe Hospital, Manchester, UK
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Affiliation(s)
- Alison Brabban
- Durham University, Mental Health Research Centre, Wolfson Research Institute, Queen's Campus, Stockton on Tees, UK.
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