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Yamaguchi S, Ojio Y, Koike J, Matsunaga A, Ogawa M, Kikuchi A, Kawashima T, Tachimori H, Bernick P, Kimura H, Inagaki A, Watanabe H, Kishi Y, Yoshida K, Hirooka T, Oishi S, Matsuda Y, Fujii C. Associations between readmission and patient-reported measures in acute psychiatric inpatients: a multicenter prospective longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02710-5. [PMID: 39102067 DOI: 10.1007/s00127-024-02710-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/24/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE This study examined whether patient-reported measures (PRMs) addressing quality of life, personal agency, functional impairment, and treatment satisfaction at hospital discharge were associated with future readmission during a 12-month follow-up period. The study also examined whether readmission influenced changes in the same measures. METHODS A multicenter prospective cohort study was conducted at 21 psychiatric hospitals in Japan. Participants completed the EuroQol-five-dimensions-five-level (EQ-5D), the Five-item Subjective Personal Agency Scale, and the Sheehan Disability Scale (SDS) at the time of index admission (T1), discharge from index admission (T2), and 6 months (T3) and 12 months (T4) after discharge. Inpatient treatment satisfaction was assessed at T2. Readmission and variables potentially associated with hospitalization and PRMs were evaluated using mixed-effects logistic regression models and mixed models for repeated measures. RESULTS A total of 491 participants were followed for 12 months (attrition rate: 19.4%), and 480 were included in the EQ-5D analysis. The most common diagnoses were schizophrenia (59%), depression (14%), and bipolar disorder (13%). No patient-reported measures were significantly associated with readmission over the follow-up period. Interaction of readmission and time did not significantly affect changes in EQ-5D. Readmission did significantly influence SDS score changes between T2 and T3 (B = 1.78, 95% CI = 0.30-3.25, p = 0.018) and between T3 and T4 (B = 1.43, 95% CI = 0.14-2.72, p = 0.029). The same influence of readmission on SDS score changes was not observed in the model which adjusted for all potential covariates. CONCLUSION Readmission was potentially associated with changes in self-reported functional impairment. Findings highlight the potential role of intensive post-discharge services in preventing readmission, rather than relying on time-of-discharge PRMs in order to predict readmission risk. TRIAL REGISTRATION This study was registered in UMIN Clinical Trials Registry (UMIN000034220).
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Affiliation(s)
- Sosei Yamaguchi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553, Japan.
| | - Yasutaka Ojio
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553, Japan
| | - Junko Koike
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553, Japan
| | - Asami Matsunaga
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553, Japan
- Department of Mental Health and Psychiatric Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Ogawa
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553, Japan
| | - Akiko Kikuchi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553, Japan
- Faculty of Human Sciences, Musashino University, Tokyo, Japan
| | - Takahiro Kawashima
- Department of Information Medicine, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan
| | - Hisateru Tachimori
- Department of Information Medicine, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan
- Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
| | - Peter Bernick
- Student Accessibility Office, Nagasaki University, Nagasaki, Japan
| | - Hiroshi Kimura
- Department of Psychiatry, Gakuji-Kai Kimura Hospital, Chiba, Japan
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chaba, Japan
| | - Ataru Inagaki
- College of Education, Psychology and Human Studies, Aoyama Gakuin University, Tokyo, Japan
| | - Hiroyuki Watanabe
- Department of Psychiatry, Gakuji-Kai Kimura Hospital, Chiba, Japan
- Division of Medical Treatment and Rehabilitation, Center of Forensic Mental Health, Chiba University, Chiba, Japan
| | - Yoshiki Kishi
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Koji Yoshida
- Department of Human Care and Support, Toyo University, Tokyo, Japan
| | - Takaaki Hirooka
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Satoru Oishi
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasuhiro Matsuda
- Osaka Psychiatric Medical Center, Osaka, Japan
- Department of Psychiatry, Nara Medical University School of Medicine, Nara, Japan
| | - Chiyo Fujii
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553, Japan
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Mansueto A, Challet-Bouju G, Hardouin JB, Grall-Bronnec M. Definitions and assessments of recovery from gambling disorder: A scoping review. J Behav Addict 2024; 13:354-412. [PMID: 38551669 PMCID: PMC11220822 DOI: 10.1556/2006.2024.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/22/2023] [Accepted: 03/04/2024] [Indexed: 06/28/2024] Open
Abstract
Background and aims While the concept of recovery is receiving increasing attention in the context of gambling disorder (GD), no consensus has yet been reached regarding its definition. This scoping review aims to map the literature on GD recovery, identify gaps, and provide insights for a more holistic and patient-centred perspective. Methods A systematic search of three databases was conducted (PubMed, PsycINFO, and ScienceDirect). Based on the method by which the results of these studies were produced, the studies included were sorted into four categories (quantitative, instrument validation, qualitative, and mixed studies) and subsequently examined using conceptual analysis. Results One hundred thirteen articles were included in this research after the screening process. In the quantitative and instrument validation studies, recovery was defined or operationalized in terms of abstinence, the absence of a GD diagnosis, or mild GD severity, or by reference to treatment outcomes or controlled gambling. A meta-synthesis of the results of the qualitative studies revealed four core features of recovery (insight, empowerment and commitment, wellbeing enhancement, and reconsideration of the issue of relapse). Discussion Discrepancies in definitions, outcomes, and variables used were evident across studies. Additionally, the quantitative and standardized approaches employed in most studies exhibited severe limitations with regard to defining recovery from the subjective and multidimensional perspectives of people recovering from GD. Conclusions This lack of definitional clarity emphasizes the necessity for further qualitative research. This research should encompass multiple stakeholder perspectives to develop a working definition promoting recovery from a holistic, patient-centred, and tailored approach.
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Affiliation(s)
- Agathe Mansueto
- Nantes Université, CHU Nantes, UIC Psychiatrie et Santé Mentale, F-44000 Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, F-44000 Nantes, France
| | - Gaëlle Challet-Bouju
- Nantes Université, CHU Nantes, UIC Psychiatrie et Santé Mentale, F-44000 Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, F-44000 Nantes, France
| | - Jean-Benoit Hardouin
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, F-44000 Nantes, France
- Department of Clinical Research and Innovation, Biostatistics and Methodology Unit, Nantes Université, CHU Nantes, F-44000 Nantes, France
- Public Health Department, Nantes Université, CHU Nantes, F-44000 Nantes, France
| | - Marie Grall-Bronnec
- Nantes Université, CHU Nantes, UIC Psychiatrie et Santé Mentale, F-44000 Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, F-44000 Nantes, France
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Okumura S, Katsuki F. Effective provider communication for personal agency in mental health recovery: A cross-sectional study on Japanese users' perspectives. J Psychiatr Ment Health Nurs 2024. [PMID: 38922746 DOI: 10.1111/jpm.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/01/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Recovery-oriented practices in community-based mental health services are of increasing importance. The recovery journey of individuals with mental illness starts with a sense of agency, and a therapeutic relationship with the providers who support them is a prerequisite. In Japan, the construction of community-based integrated care systems for individuals with mental illness is positioned as a priority health issue, with communication with familiar individuals being particularly important for recovery in Japanese and Asian cultures. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first to examine effective communication factors for personal agency in the recovery of individuals with mental illness, focusing on addressing uncertainty about treatment choices and dissatisfaction with decision-making, and considering the user's personal recovery journey. In recovery-oriented practice, it is important to prioritize addressing the emotional aspects of decision-making alongside the mental illness condition, supporting users' self-determination in their unique recovery journeys. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings emphasized the need to actively engage with users' perspectives and emotions, emphasize shared life planning, and foster a therapeutic relationship based on partnership. Providers should approach dialogue as carefully as medication prescriptions, prioritizing the establishment of an effective therapeutic relationship with the user. These characteristics are essential for developing a strong therapeutic relationship and effectively facilitating users' recovery. The findings are applicable not only to nurses but to all mental health service providers, contributing to the advancement of recovery-oriented practice. ABSTRACT INTRODUCTION: Recovery-oriented practice in community-based mental health services is crucial for individuals with mental illness, with communication with familiar individuals being important for recovery in Japanese and Asian cultures. AIM This study aimed to examine effective communication factors for personal agency in recovery by investigating the association between perceived support provided through communication and personal agency of individuals with mental illness. METHOD A cross-sectional study was conducted among community-dwelling Japanese mental health service users, assessing subjective agency, decisional conflict, staff support for personal recovery, activation for mental health self-management, demographic variables and living difficulties. Multiple linear regression analysis identified factors predicting subjective agency, revealing characteristics of effective provider communication for recovery. RESULTS Data from 222 users were analysed, revealing negative correlations between uncertainty about treatment choices and ineffective decision-making with higher subjective agency, while staff support for personal recovery positively correlated with higher subjective agency. DISCUSSION In recovery-oriented practice, prioritizing users' emotional experiences during decision-making and supporting their self-determination in their unique recovery journeys is crucial. IMPLICATIONS FOR PRACTICE Providers should approach dialogue as carefully as medication prescriptions, prioritizing therapeutic partnerships with users. The findings extend beyond nursing to all mental health service providers, advancing the theory of recovery-oriented practice.
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Affiliation(s)
- Satoshi Okumura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fujika Katsuki
- Department of Psychiatric and Mental Health Nursing, Nagoya City University Graduate School of Nursing, Nagoya, Japan
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Egger JR, Kaaya S, Swai P, Lawala P, Ndelwa L, Temu J, Bukuku ES, Lukens E, Susser E, Dixon L, Minja A, Clari R, Martinez A, Headley J, Baumgartner JN. Functioning and quality of life among treatment-engaged adults with psychotic disorders in urban Tanzania: Baseline results from the KUPAA clinical trial. PLoS One 2024; 19:e0304367. [PMID: 38889160 PMCID: PMC11185462 DOI: 10.1371/journal.pone.0304367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND There is a treatment gap for those living with severe mental illnesses in low- and middle-income countries, yet not enough is known about those who are currently accessing clinical services. A better understanding of potentially modifiable factors associated with functioning and quality of life will help inform policies and programming. AIMS To describe the functioning and quality of life for a psychiatric treatment-engaged population living with psychotic disorders in two urban areas of Tanzania, and to explore their respective correlates. METHODS This study analyzed cross-sectional data from 66 individuals enrolled in the Kuwezeshana Kupata Uzima (KUPAA) pilot clinical trial who had a diagnosis of schizophrenia or schizoaffective disorder, recent relapse, and who were receiving outpatient treatment. Baseline functioning (WHO Disability Assessment Schedule 2.0) and quality of life (WHO Quality of Life BREF scale) were measured. Univariable and multivariable regression analyses were conducted to determine correlates of functioning and quality of life. RESULTS Adjusted analyses indicated that higher disability was associated with higher food insecurity, more symptomatology, more self-stigma, less instrumental support, less hope, lower self-efficacy, and/or lower levels of family functioning. Higher quality of life was associated with higher levels of self-efficacy, more hopefulness, more instrumental support, less self-stigma, and better family functioning. CONCLUSIONS Identification of factors associated with disability and quality of life can help clinicians and policymakers, as well as consumers of mental health services, to better co-design and target psychosocial interventions to optimize their impact in low-resource settings. TRIAL REGISTRATION Trial registration: ClinicalTrials.gov # NCT04013932, July 10, 2019.
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Affiliation(s)
- Joseph R. Egger
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Sylvia Kaaya
- Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Praxeda Swai
- Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Lawala
- Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | | | - Joseph Temu
- Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ellen Lukens
- School of Social Work, Columbia University, New York, NY, United States of America
- New York State Psychiatric Institute, New York, NY, United States of America
| | - Ezra Susser
- New York State Psychiatric Institute, New York, NY, United States of America
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, NY, United States of America
- Department of Psychiatry, Columbia University, New York, NY, United States of America
| | - Anna Minja
- Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Rosarito Clari
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Alyssa Martinez
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Felix S, Valery KM, Caiada M, Guionnet S, Bonilla-Guerrero J, Destaillats JM, Prouteau A. Personal recovery self-report outcome measures in serious mental illness: A systematic review of measurement properties. Clin Psychol Rev 2024; 112:102459. [PMID: 38943916 DOI: 10.1016/j.cpr.2024.102459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/26/2024] [Accepted: 06/10/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Personal recovery represents a paradigm shift in mental healthcare. Validated self-report outcome measures (PROMs) are needed to facilitate the transformation towards recovery-oriented practices and services. Objectives were to identify published measures and analyze their measurement properties using a standardized methodology. METHODS Following the COSMIN guidelines, we conducted a systematic review of personal recovery PROMs in serious mental illness. The MEDLINE, PMC, PsycINFO, PsycARTICLES, PBSC and Scopus electronic databases were searched for articles published between May 2012 and February 2024. Full-text articles from a previous systematic review were also examined. RESULTS 91 studies were included in the review, describing 25 PROMs. Ten of them had not been identified in previous reviews. Quality of evidence was globally poor for most PROM measurement properties. Very little evidence was found for cross-cultural validity, measurement invariance, measurement error and criterion validity. The Recovery Assessment Scale and Questionnaire about the Process of Recovery showed the strongest evidence for sufficient psychometric data on a wide range of measurement properties. CONCLUSIONS Several personal recovery measures are now available. While research is still needed to enhance their validity on some psychometric properties, the current tools appear sufficient to cover most research and clinical needs.
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Affiliation(s)
- Simon Felix
- Psychology Laboratory (LabPsy) UR4139, Bordeaux University, 3 ter place de la Victoire, 33000 Bordeaux, France; ESPPAIR Unit, Department of Adult Psychiatry, Jonzac Hospital, 17500 Saint-Martial de Vitaterne, France.
| | - Kevin-Marc Valery
- Psychology Laboratory (LabPsy) UR4139, Bordeaux University, 3 ter place de la Victoire, 33000 Bordeaux, France
| | - Meryl Caiada
- Psychology Laboratory (LabPsy) UR4139, Bordeaux University, 3 ter place de la Victoire, 33000 Bordeaux, France
| | - Sarah Guionnet
- Psychology Laboratory (LabPsy) UR4139, Bordeaux University, 3 ter place de la Victoire, 33000 Bordeaux, France
| | - Julien Bonilla-Guerrero
- ESPPAIR Unit, Department of Adult Psychiatry, Jonzac Hospital, 17500 Saint-Martial de Vitaterne, France
| | - Jean-Marc Destaillats
- ESPPAIR Unit, Department of Adult Psychiatry, Jonzac Hospital, 17500 Saint-Martial de Vitaterne, France
| | - Antoinette Prouteau
- Psychology Laboratory (LabPsy) UR4139, Bordeaux University, 3 ter place de la Victoire, 33000 Bordeaux, France; ESPPAIR Unit, Department of Adult Psychiatry, Jonzac Hospital, 17500 Saint-Martial de Vitaterne, France
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Gang M, Gwak D. Factors Influencing the Personal Recovery of Inpatients in a Forensic Psychiatric Hospital in South Korea. JOURNAL OF FORENSIC NURSING 2024:01263942-990000000-00092. [PMID: 38888417 DOI: 10.1097/jfn.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
PURPOSE This study aimed to identify the factors influencing the personal recovery of inpatients of a forensic psychiatric hospital. METHODS A descriptive study design was assigned. The participants were 136 inpatients in a forensic psychiatric hospital in South Korea. The data were analyzed using SPSS Statistics Version 26.0 with descriptive statistics, independent t test, analysis of variance, Pearson correlation coefficient, and multiple regression. RESULTS Perceived physical health status (β = 0.16, p = 0.034), perceived mental health status (β = 0.20, p = 0.023), perceived family support (β = 0.17, p = 0.013), duration of hospitalization (β = 0.25, p < 0.001), and recovery attitudes (β = 0.36, p < 0.001) were the significant factors explaining 42.6% of the variance in the personal recovery of participants. CONCLUSION The findings of this study indicate that recovery attitudes, health status, and personal support affect forensic mental health personal recovery. Personal recovery can be strengthened through nursing intervention and support to strengthen recovery attitudes and health status. It is necessary to get used to personal recovery through long-term and systematic education, and organizations and nurses need to make efforts to provide services centered on personal recovery.
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Affiliation(s)
- Moonhee Gang
- Author Affiliation: College of Nursing, Chungnam National University
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Liu WI, Hsieh WL, Lai CT, Liu CC, Tai YM, Liu CY. Effectiveness of a needs-tailored nurse-led recovery program for community-dwelling people with schizophrenia: a cluster-randomized controlled trial. BMC Nurs 2024; 23:329. [PMID: 38755582 PMCID: PMC11097421 DOI: 10.1186/s12912-024-01986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Meeting people's needs is positively correlated with their recovery. However, recovery services rarely include nurse-led programs tailored to the needs of these people. This study aimed to evaluate the effectiveness of a new needs-tailored recovery program by using a cluster-randomized controlled trial design. METHODS We conducted a parallel randomized controlled trial in two community psychiatric departments, employing nurse-level clustering for intervention delivery and selecting participants through convenience sampling. The participants were people diagnosed with schizophrenia that were receiving homecare services. The experimental group (n = 82) received needs-tailored recovery program for six months. The control group (n = 82) received traditional homecare. Data were collected at baseline, post-intervention, and the three-month follow-up (the study ran from February to December 2021). The outcomes were recovery, needs, hope, empowerment, psychotic symptoms, and medication adherence. We used repeated measures ANOVA tests to examine the effect of the group × time interaction. RESULTS The participants in the experimental group demonstrated statistically significant improvements in recovery, hope, and medication adherence compared to the control group, both immediately post-intervention and at the three-month follow-up. Moreover, they exhibited statistically significant reductions in needs compared to the control group at the three-month follow-up (p < .05). While the interaction effect for psychotic symptoms was not significant, the time effect was significant (p < .05). No significant interaction or time effect was observed for empowerment. CONCLUSION The findings increase our understanding of recovery-oriented care that prioritizes therapeutic alliance, integrated needs assessment, individual goals, hope, and empowerment. TRIAL REGISTRATION The Clinicaltrials.gov identifier NCT05304780 retrospectively registered on 03/31/2022.
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Affiliation(s)
- Wen-I Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.
| | - Wen-Ling Hsieh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Ching-Ting Lai
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Chia-Chen Liu
- Tri-Service General Hospital Beitou Branch, Taipei City, Taiwan
| | - Yueh-Ming Tai
- Tri-Service General Hospital Beitou Branch, Taipei City, Taiwan
| | - Chieh-Yu Liu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
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Moeller SB, Larsen PV, Austin S, Slade M, Arendt IMTP, Andersen MS, Simonsen S. Scalability, test-retest reliability and validity of the Brief INSPIRE-O measure of personal recovery in psychiatric services. Front Psychiatry 2024; 15:1327020. [PMID: 38807686 PMCID: PMC11130469 DOI: 10.3389/fpsyt.2024.1327020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/29/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Mental health services have transitioned from treating symptoms to emphasizing personal recovery. Despite its importance, integrating personal recovery into clinical practice remains work in progress. This study evaluates the psychometric qualities of the Brief INSPIRE-O, a five-item patient-reported outcome measure assessing personal recovery. Method The study collected data from 2018 to 2020 at the Mental Health Services, Capital Region of Denmark, using an internet-based system examining 8,192 non-psychotic patients - receiving outpatient treatment. Materials This study evaluated the Brief INSPIRE-O and used measures of symptomatology (SCL-10), well-being (WHO-5), and social functioning (modified SDS). Results The study population comprised 76.8% females with a mean age of 32.9 years, and diagnoses included anxiety (28%), depression (34%), and personality disorder (19%). The mean Brief INSPIRE-O score (39.9) was lower than the general population norm (71.1). The Brief INSPIRE-O showed acceptable test-retest reliability (0.75), scalability (0.39), and internal consistency (0.73). Correlations with other mental health criteria were in the expected direction for symptomatology (-0.46), well-being (0.60), and social functioning (-0.43) and remained consistent across diagnoses. Discussion The Brief INSPIRE-O demonstrated strong psychometric qualities and could be recommended as a measure of personal recovery for use in both research and clinical practice. Its strong theoretical basis and short completion time make it suitable for use for research. Incorporating Brief INSPIRE-O into clinical assessment will further support the process of mental health systems re-orientating towards personal recovery.
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Affiliation(s)
- Stine Bjerrum Moeller
- Psychotherapeutic Center Stolpegård, Region Hovedstad Psychiatry, København, Denmark
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Trauma and Torture Survivors, Mental Health Services of Southern Denmark, Vejle, Denmark
| | - Pia Veldt Larsen
- Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Stephen Austin
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Mike Slade
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Ida-Marie T. P. Arendt
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Trauma and Torture Survivors, Mental Health Services of Southern Denmark, Vejle, Denmark
| | | | - Sebastian Simonsen
- Psychotherapeutic Center Stolpegård, Region Hovedstad Psychiatry, København, Denmark
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
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Watanabe S, Taniguchi T, Sugihara M. Information gathered through draws-to-decision, social functioning, and personal recovery among patients with schizophrenia in Japan. Cogn Neuropsychiatry 2024; 29:208-218. [PMID: 38954431 DOI: 10.1080/13546805.2024.2367269] [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: 11/28/2022] [Accepted: 06/05/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION In schizophrenia, social functioning and personal recovery are pivotal outcomes potentially influenced by cognitive biases such as Jumping to Conclusions (JTC). Despite their significance, the relationship between JTC, social functioning, and personal recovery remains unclear. This study aims to investigate this relationship to inform tailored interventions for schizophrenia management. METHODS Data were collected from 94 schizophrenia patients using standardised measures. The Beads Task assessed JTC, whereas the Brief PANSS, TMT-J, SLOF-J, and RAS-J evaluated psychiatric symptoms, neurocognitive functioning, social functioning, and personal recovery, respectively. Statistical analyses included correlation and hierarchical regression. RESULTS Correlation analyses revealed a significant negative correlation between JTC and personal recovery (r = -0.27, p < 0.05). Hierarchical regression indicated JTC as a significant negative predictor of personal recovery (β = -0.33, p = 0.01). No significant correlation was found between JTC and social functioning. DISCUSSION Increased JTC was associated with lower levels of personal recovery in schizophrenia patients, independent of demographic and clinical factors. In the case of individuals with schizophrenia who demonstrate JTC, there is a potential to suggest the paradox of insight or apparent personal recovery scores.
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Affiliation(s)
- Seiichi Watanabe
- Department of Occupational Therapy, Medical Corporation Nasukougen Hospital, Nasu-machi, Japan
- Division of Occupational Therapy, Doctoral Program in Health Sciences, Graduate School of Health and Welfare Sciences, Ohtawara, Japan
| | - Takamichi Taniguchi
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Chiba, Japan
| | - Motoko Sugihara
- Retired, Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Tokyo, Japan
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Zhu D, Lyu K. Anti-stigmatizing: a collaborative autoethnography on recovery from depression. Front Psychiatry 2024; 15:1360967. [PMID: 38690206 PMCID: PMC11059567 DOI: 10.3389/fpsyt.2024.1360967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/11/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Despite extensive research on clinical treatments for depression, there remains a significant gap in understanding of the lived experiences and recovery journeys of those with depression. This study sought to explore the recovery process through an "anti-stigmatizing" lens, emphasizing the cultural-psychological mechanisms at play and the importance of personal narratives in shaping the recovery trajectory. Methods Using a collaborative autoethnographic approach, this report focuses on the first author's journey of depression recovery. This research methodology allows for an in-depth exploration of subjective experiences, with a specific emphasis on the interaction between societal stigma, personal identity, and mental-health challenges. Results It is found that the depression-recovery experience can be divided into four stages from an anti-stigma perspective: (1) encountering the public stigma of emotions; (2) internalizing the stigma to a self-stigma; (3) "decriminalizing" the expected stigma of a "depressed" identity through diagnosis; and (4) being able to cope with and understanding the public stigma relating to depression when facing it again. Key factors that were found to contribute to recovery were self-awareness, community empowerment, and recognition and acceptance by close friends and family. Discussion We propose a reconceptualization of depression that incorporates a societal perspective on internalized stigma. Recovery from depression is not merely a medical process; it also pertains to how the patient frees themselves from public stigma. The results strongly indicate the need for a paradigm shift toward a more inclusive and empathetic approach to mental-health care, and we emphasize the importance of personal narratives in depression recovery.
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Affiliation(s)
- Danlei Zhu
- Institute of Vocational & Adult Education, East China Normal University, Shanghai, China
| | - Keyi Lyu
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, China
- Chinese Education Modernization Research Institute of Hangzhou Normal University, Hangzhou, China
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de Winter L, Jelsma A, Vermeulen JM, van Weeghel J, Hasson-Ohayon I, Mulder CL, Boonstra N, Veling W, de Haan L. Long-term Changes in Personal Recovery and Quality of Life Among Patients With Schizophrenia Spectrum Disorders and Different Durations of Illness: A Meta-analysis. Schizophr Bull 2024:sbae045. [PMID: 38613256 DOI: 10.1093/schbul/sbae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND AND HYPOTHESIS In schizophrenia spectrum disorders (SSD) personal recovery and subjective quality of life (S-QOL) are crucial and show conceptual overlap. There is limited knowledge about how these outcomes change over time. Therefore, we investigated changes in personal recovery or S-QOL for patients with SSD. We specifically focused on the influence of the patients' durations of illness (DOI) on changes in personal recovery and S-QOL. STUDY DESIGN We included 46 studies investigating longitudinal changes in quantitative assessments of personal recovery or S-QOL for patients with SSD. Outcomes were categorized in overall personal recovery, overall S-QOL connectedness, hope and optimism, identity, meaning in life, and empowerment. We evaluated effect sizes of change between baseline and follow-up assessments. We also evaluated potential moderating effects, including DOI on these changes in outcomes. STUDY RESULTS We found small improvements of overall personal recovery and S-QOL, but marginal or no improvement over time in the other more specific outcome domains. Patients without a schizophrenia diagnosis, a younger age, and more recent publications positively influenced these changes. We found no significant influence of DOI on the changes in any outcome domain. CONCLUSIONS Improvement in personal recovery or S-QOL of people with SSD is modest at best. However, these studies did not fully capture the personal narratives or nonlinear process of recovery of an individual. Future research should focus on how to shift from a clinical to more person-oriented approach in clinical practice to support patients in improving their personal process of recovery. REVIEW PROTOCOL REGISTRATION CRD42022377100.
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Affiliation(s)
- Lars de Winter
- Phrenos Center of Expertise, Utrecht, the Netherlands
- Department of Psychiatry, Amsterdam UMC location AMC, Amsterdam, the Netherlands
| | - Auke Jelsma
- Department of Psychiatry, Amsterdam UMC location AMC, Amsterdam, the Netherlands
| | - Jentien M Vermeulen
- Department of Psychiatry, Amsterdam UMC location AMC, Amsterdam, the Netherlands
| | | | | | - Cornelis L Mulder
- Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, Rotterdam, the Netherlands
- Parnassia Psychiatric Institute, Rotterdam, the Netherlands
| | - Nynke Boonstra
- NHL Stenden University of Applied Science, Leeuwarden, the Netherlands
- University Medical Center Utrecht, Division Neuroscience, Utrecht, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC location AMC, Amsterdam, the Netherlands
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12
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Mori T, Hattori R, Irie K, Tsurumi K, Murai T, Ishii R, Inadomi H. Relationship between personal recovery, autobiographical memory, and clinical recovery in people with mental illness in the acute phase. Heliyon 2024; 10:e26075. [PMID: 38390044 PMCID: PMC10881879 DOI: 10.1016/j.heliyon.2024.e26075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Aim Narratives are important in psychiatric rehabilitation. People with a psychiatric diagnosis find it difficult to recall specific autobiographical memories of events that lasted less than a day. Although personal narratives play a central role in personal recovery, the factors influencing personal and clinical recovery, such as psychiatric symptoms and cognitive function, have not been fully explored. Therefore, this study examined the associations between personal recovery and autobiographical memory, age, psychiatric symptoms, and neurocognitive function. Method The Self-Identified Stage of Recovery, Parts A and B (SISR-A, SISR-B), Autobiographical Memory Test (AMT), Japanese version of the Brief Assessment Scale of Schizophrenia Cognitive Function, and Brief Psychiatric Symptom Rating Scale were administered to 40 individuals with psychiatric disorders who were undergoing psychiatric rehabilitation. Results A significant positive correlation was found between the total number of specific memories in the AMT and total SISR-B scores. A binary logistic regression analysis revealed that the total number of specific memories, especially high responsiveness to negative cue words, significantly predicted greater personal recovery. Age, psychiatric symptoms, and neurocognitive function did not significantly predict higher personal recovery. Conclusion In psychiatric rehabilitation, negative episodes should be treated with caution; however, they may also facilitate personal recovery.
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Affiliation(s)
- Taisuke Mori
- Department of Day Care Unit, Kyoto University Hospital, Japan
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Japan
| | - Ritsuko Hattori
- Department of Day Care Unit, Kyoto University Hospital, Japan
| | - Keisuke Irie
- Kyoto University Graduate School of Medicine, Japan
| | | | | | - Ryouhei Ishii
- Osaka Metropolitan University Graduate School of Rehabilitation Science, Japan
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Simonsen C, Åsbø G, Slade M, Wold KF, Widing L, Flaaten CB, Engen MJ, Lyngstad SH, Gardsjord E, Bjella T, Romm KL, Ueland T, Melle I. A good life with psychosis: rate of positive outcomes in first-episode psychosis at 10-year follow-up. Psychol Med 2024:1-10. [PMID: 38389456 DOI: 10.1017/s0033291724000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND More knowledge about positive outcomes for people with first-episode psychosis (FEP) is needed. An FEP 10-year follow-up study investigated the rate of personal recovery, emotional wellbeing, and clinical recovery in the total sample and between psychotic bipolar spectrum disorders (BD) and schizophrenia spectrum disorders (SZ); and how these positive outcomes overlap. METHODS FEP participants (n = 128) were re-assessed with structured clinical interviews at 10-year follow-up. Personal recovery was self-rated with the Questionnaire about the Process of Recovery-15-item scale (total score ⩾45). Emotional wellbeing was self-rated with the Life Satisfaction Scale (score ⩾5) and the Temporal Experience of Pleasure Scale (total score ⩾72). Clinical recovery was clinician-rated symptom-remission and adequate functioning (duration minimum 1 year). RESULTS In FEP, rates of personal recovery (50.8%), life satisfaction (60.9%), and pleasure (57.5%) were higher than clinical recovery (33.6%). Despite lower rates of clinical recovery in SZ compared to BD, they had equal rates of personal recovery and emotional wellbeing. Personal recovery overlapped more with emotional wellbeing than with clinical recovery (χ2). Each participant was assigned to one of eight possible outcome groups depending on the combination of positive outcomes fulfilled. The eight groups collapsed into three equal-sized main outcome groups: 33.6% clinical recovery with personal recovery and/or emotional wellbeing; 34.4% personal recovery and/or emotional wellbeing only; and 32.0% none. CONCLUSIONS In FEP, 68% had minimum one positive outcome after 10 years, suggesting a good life with psychosis. This knowledge must be shared to instill hope and underlines that subjective and objective positive outcomes must be assessed and targeted in treatment.
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Affiliation(s)
- Carmen Simonsen
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Gina Åsbø
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, 7801 Namsos, Norway
| | - Kristin Fjelnseth Wold
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Line Widing
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Camilla Bärthel Flaaten
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Johan Engen
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Siv Hege Lyngstad
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erlend Gardsjord
- Section for Treatment of Early Psychosis, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Thomas Bjella
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Quistgaard M, Myklebust OLP, Aure T, Austin SF, Berring LL, Vernal DL, Storebø OJ. Psychosocial interventions promoting personal recovery in people with schizophrenia: a scoping review protocol. BMJ Open 2023; 13:e073901. [PMID: 38070925 PMCID: PMC10729100 DOI: 10.1136/bmjopen-2023-073901] [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: 03/24/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Personal recovery is an important aspect for many individuals diagnosed with schizophrenia, as people can live rich, fulfilling lives despite ongoing symptoms. Prior reviews have found several factors to be associated with personal recovery, but a comprehensive overview of the psychosocial interventions aimed at improving personal recovery in schizophrenia is needed. METHODS AND ANALYSIS Key terms relating to personal recovery and psychosocial interventions to promote personal recovery will be searched for in the following databases: PubMed, EMBASE, PsycINFO, CINAHL, MEDLINE, Google Scholar, Web of Science Core Collection and Cochrane. Additionally, a simple search for grey literature will be conducted in The Networked Digital Library of Theses and Dissertations. Two reviewers will individually screen and extract the data, and the selection of sources will be documented in a Preferred Reporting Items for Systematic reviews and Meta-Analyses flow chart. A content analysis will be conducted on the data, and the findings will be presented in tables, and narratively synthesised. Lastly, research gaps will be identified, and recommendations for future research will be proposed. ETHICS AND DISSEMINATION Ethics approval was not required for the development or publishing of this protocol. Findings will be disseminated through conferences, meeting with patient organisations and consumers, and published in a peer-reviewed scientific journal.
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Affiliation(s)
- Maria Quistgaard
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
| | | | | | - Stephen Fitzgerald Austin
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Mental Health Services, East, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Lauge Berring
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Institute for Regional Sundhedsforskning (IRS), University of Southern Denmark, Odense, Denmark
| | - Ditte Lammers Vernal
- Psychiatry, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, North Denmark Region, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Vogel JS, Bruins J, Swart M, Liemburg E, van der Gaag M, Castelein S. Effects of an eating club for people with a psychotic disorder on personal recovery: Results of a randomized controlled trial. J Behav Ther Exp Psychiatry 2023; 81:101871. [PMID: 37315478 DOI: 10.1016/j.jbtep.2023.101871] [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: 12/13/2021] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Many people with a psychotic disorder are coping with severe psychosocial limitations related to their illness. The current randomized controlled trial (RCT) investigates the effects of an eating club intervention (HospitalitY (HY)) aimed to improve personal and societal recovery. METHODS In 15 biweekly sessions participants received individual home-based skill training and guided peer support sessions in groups of three participants from a trained nurse. A multi-center RCT was conducted (intended sample size: n = 84; n = 7 per block) in patients with a diagnosis of schizophrenia spectrum receiving community treatment. HospitalitY was compared to a Waiting List Control (WLC) condition at three time points (baseline, end-of-treatment (8 months) and follow-up (12 months)) using personal recovery as primary outcome and loneliness, social support, self-stigma, self-esteem, social skills, (social) functioning, independency competence, and psychopathology as secondary outcomes. Outcomes were evaluated with a mixed modeling statistical procedure. RESULTS The HY-intervention had no significant effects on personal recovery or secondary outcomes. More attendance was associated with higher scores on social functioning. LIMITATIONS With N = 43 participants included, power was insufficient. Seven HY-groups were started, from which three discontinued before the sixth meeting, one HY group stopped due the start of the COVID-19 pandemic. CONCLUSIONS Despite a promising pilot study on feasibility, the current RCT did not show any effects of the HY intervention. A mixed qualitative-quantitative research methods might be more appropriate for researching the HospitalitY-intervention to investigate what social and cognitive processes are at play in this peer guided social intervention.
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Affiliation(s)
- Jelle Sjoerd Vogel
- Lentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Faculty of Behavioural and Social Sciences, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, P.O. 30001, 9700 RB, Groningen, the Netherlands.
| | - Jojanneke Bruins
- Lentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, P.O. 30001, 9700 RB, Groningen, the Netherlands
| | - Marte Swart
- Lentis Psychiatric Institute, Flexible Assertive Community Treatment Groningen, Hereweg 80, 9725 AG, Groningen, the Netherlands
| | - Edith Liemburg
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, P.O. 30001, 9700 RB, Groningen, the Netherlands
| | - Mark van der Gaag
- VU University Amsterdam, Department of Clinical Psychology, Van der Boechorststraat 1, 1081 BR, Amsterdam, the Netherlands; Amsterdam Public Mental Health Research Institute, Van der Boechorststraat 1, 1081 BR, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512 HN, The Hague, the Netherlands
| | - Stynke Castelein
- Lentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Faculty of Behavioural and Social Sciences, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, P.O. 30001, 9700 RB, Groningen, the Netherlands
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Faith L, Wiesepape C, Kukla M, Lysaker P. Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation. Neuropsychiatr Dis Treat 2023; 19:2179-2194. [PMID: 37873532 PMCID: PMC10590553 DOI: 10.2147/ndt.s386004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
Introduction Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients' experience of recovery oriented approaches, there are less studies examining clinicians' perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis. Methods Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services. Results Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work. Discussion As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.
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Affiliation(s)
- Laura Faith
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Courtney Wiesepape
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Paul Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Leamy M, Foye U, Hirrich A, Bjørgen D, Silver J, Simpson A, Ellis M, Johan-Johanson K. A systematic review of measures of the personal recovery orientation of mental health services and staff. Int J Ment Health Syst 2023; 17:33. [PMID: 37849003 PMCID: PMC10580616 DOI: 10.1186/s13033-023-00600-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
PURPOSE This review aimed to update and extend the Williams and colleagues 2012 systematic review of measures of recovery-orientation of mental health services by examining whether any of the specific knowledge gaps identified in this original review had subsequently been addressed. METHODS A systematic review using CINAHL, ASSIA, Embase, PsycINFO, Medline and other sources, searched from 2012 until 2021. The conceptualisation of recovery and recovery-orientation of services was explored. Psychometric properties of measures were evaluated using quality criteria and according to ease of use. RESULTS Fourteen measures assessing aspects of the recovery orientation of services and staff were identified, of which ten met the eligibility. Psychometric properties were evaluated, and conceptualisations of recovery and recovery-orientation of services investigated. CONCLUSION After over a decade of research in the field of recovery outcome measurement, there remains a lack of a single gold-standard measure of recovery-orientation of mental health services. There is a need for researchers to develop a new gold standard measure of recovery-orientation of services that is psychometrically valid and reliable, demonstrates sensitivity to change and is easy to use. It needs to show a good fit to an underpinning conceptual model/ framework of both personal recovery and recovery-oriented services and/or systems, with different versions for stakeholders at each level of an organisation or system.
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Affiliation(s)
- Mary Leamy
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Una Foye
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Anne Hirrich
- KBT Competence Center for lived experience and service development, Trondheim, Norway
| | - Dagfin Bjørgen
- KBT Competence Center for lived experience and service development, Trondheim, Norway
| | | | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Madeline Ellis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Karl Johan-Johanson
- KBT Competence Center for lived experience and service development, Trondheim, Norway
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de Bruijn E, Jochems EC, Wierdsma AI, Voskes Y. The Overlooked Part of Flexible Assertive Community Treatment-A Retrospective Study on Factors Related to Discharge from FACT for Clients with a Psychotic Disorder. Community Ment Health J 2023; 59:1313-1320. [PMID: 37086300 PMCID: PMC10447266 DOI: 10.1007/s10597-023-01115-z] [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: 09/28/2022] [Accepted: 03/08/2023] [Indexed: 04/23/2023]
Abstract
Flexible assertive community treatment (FACT) is a recovery-based treatment and its manual describes discharge criteria for clients who are recovered. Yet research on discharge is lacking. In this retrospective and observational study, between 2009 and 2019, we explored how sociodemographic, clinical, and treatment factors are associated with planned discharge or no discharge. We included 1734 clients with a psychotic disorder of which 38.5% were discharged after a mutual decision that FACT was no longer necessary. Logistic regression analysis was used to create a discharge profile which was more favorable for discharged clients. They were older at the start of FACT, had lower HoNOS scores, were diagnosed with another psychotic disorder, and had fewer contacts with non-FACT members. Discharge is a part of FACT and is more common than anticipated. While this study provides preliminary answers, further research is necessary to better understand discharge and its associated factors.
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Affiliation(s)
- Eva de Bruijn
- GGZ Breburg, Tilburg, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | | | | | - Yolande Voskes
- GGZ Breburg, Tilburg, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
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Goodman-Casanova JM, Cuesta-Lozano D, Alupoaei C, Grasa Bello EM, Herrera-Imbroda J, Mayoral-Cleries F, Guzman-Parra J. Psychometric validation of the 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP). Front Psychol 2023; 14:1178341. [PMID: 37484089 PMCID: PMC10356816 DOI: 10.3389/fpsyg.2023.1178341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/04/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Reliable and valid instruments are needed to measure the impact of mental health services and programs on the journeys of recovery of service users. The aim of this study was to explore the psychometric properties of the cross-culturally adapted 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP). Methods One hundred and ten participants from three locations in Spain (Málaga, Barcelona and Madrid), who were users of primary and specialized mental health services, were interviewed from October 2021 to June 2022. Results The internal consistency obtained was excellent: ω =.93 and α =.92. Temporal reliability using intraclass correlation coefficients was moderate (ICC=.684, p <.000). Regarding convergent validity, the QPR-15-SP had a moderate correlation with the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) (ρ =-.500, p <.000), a Visual Numeric Recovery Scale (VNRS) (ρ =.591, p <.000), and the Stages of Recovery Instrument (STORI) (r =.566, p <.000). Correlations between advanced stages of recovery and higher QPR-15-SP scores were found (Moratorium: ρ =-.579, p <.000; Awareness: ρ =-.130, p =.189; Preparation: r =-.043, P=.665; Rebuilding: r =.460, p <.000; Growth: ρ =.697, p <.000). In terms of divergent validity, the QPR-15-SP had low correlation with the DUKE-UNC Functional Social Support Scale (ρ =.273, p <.005). The confirmatory factor analysis of the 1-factor structure obtained reasonable goodness of fit indexes. Discussion The QPR-15-SP has acceptable psychometric properties, providing support for measuring recovery in Spain and allowing international comparison research.
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Affiliation(s)
- Jessica Marian Goodman-Casanova
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Departamento de Enfermería y Fisioterapia, Universidad de Alcalá, Madrid, Spain
| | | | - Catalina Alupoaei
- Departamento de Enfermería y Fisioterapia, Universidad de Alcalá, Madrid, Spain
| | - Eva María Grasa Bello
- Mental Health, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBESAM), Madrid, Spain
| | - Jesús Herrera-Imbroda
- Grupo de Neuropsicofarmacología, Hospital Regional Universitario de Málaga - Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina–IBIMA Plataforma Bionand, Málaga, Spain
- Departamento Farmacología y Pediatría, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Fermin Mayoral-Cleries
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Jose Guzman-Parra
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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20
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de Haan L, Linszen D, Wouters L, Zwinderman K, Dingemans P. Sustained specialized and family treatment in first-episode schizophrenia or related disorders: a 5-year randomized controlled trial. Psychol Med 2023; 53:4316-4323. [PMID: 35672956 PMCID: PMC10388306 DOI: 10.1017/s003329172200099x] [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: 12/14/2021] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The long-term outcome of first-episode schizophrenia needs improvement. Here, we evaluate the effectiveness of 5 years sustained specialist treatment (ST), ST including Parent groups (ST + P) or treatment as usual (TAU) on psychotic relapse and social functioning. METHODS A three condition randomized, parallel assigned, single-blind efficacy trial, in which 198 first-episode psychosis (FEP) patients aged 15-28 years were included. The effect on time to first relapse, first relapse rates, mean number of relapses per patient, and time to the improvement of social functioning were analyzed using Cox regression or ANOVA. RESULTS We found no significant differences between treatment conditions in the ITT analysis concerning time to first relapse, nor first relapse rate. Mean number of relapses per patient differed at a trend level between ST, ST + P or TAU conditions, respectively: 0.72; 0.62 or 1.02 (p = 0.069). No evidence was found for differential effect of treatment conditions on social functioning. CONCLUSION Five years sustained ST of FEP nor addition of parent groups increased time to first relapse or reduced first relapse rate, compared to sustained TAU. Indications for favorable effects of parent groups were found on relapses per patient.
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Affiliation(s)
- Lieuwe de Haan
- Department of Psychiatry, Early Psychosis, Amsterdam UMC, Amsterdam
| | - Don Linszen
- Department of Psychiatry, Early Psychosis, Amsterdam UMC, Amsterdam
| | - Luuk Wouters
- Department of Psychiatry, Early Psychosis, Amsterdam UMC, Amsterdam
| | | | - Peter Dingemans
- Department of Psychiatry, Early Psychosis, Amsterdam UMC, Amsterdam
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21
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Concerto C, Rodolico A, Mineo L, Ciancio A, Marano L, Romano CB, Scavo EV, Spigarelli R, Fusar-Poli L, Furnari R, Petralia A, Signorelli MS. Exploring Personal Recovery in Schizophrenia: The Role of Mentalization. J Clin Med 2023; 12:4090. [PMID: 37373783 DOI: 10.3390/jcm12124090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Recovery is a broadly debated concept in the field of psychiatry research and in schizophrenia. Our study aims to understand the correlation between personal recovery from schizophrenia and factors such as mentalization, disability, quality of life, and antipsychotic side effects; Methods: Participants with schizophrenia (according to DSM-5 criteria) were consecutively recruited from the Psychiatry Unit of the University of Catania, Italy. Participants were assessed with the Recovery Assessment Scale (RAS), the Multidimensional Mentalizing Questionnaire (MMQ), the brief version of the WHO Disability Assessment Schedule (WHO-DAS), the EuroQoL-5 dimensions-5 levels, the Insight Orientation Scale (IOS) and the Glasgow Antipsychotic Side Effect Scale (GASS); Results: 81 patients were included. Our findings showed a positive correlation between RAS total scores and MMQ scores, especially in "good mentalizing" subdomains. IOS scores also had a positive association with RAS and MMQ scores. In contrast, poor mentalizing abilities negatively correlated with WHO-DAS 2.0 scores. While antipsychotic side effects influenced functioning, they did not impact perceived recovery. Conclusions: The study's results identified potential predictors of personal recovery from schizophrenia. These findings could contribute to creating tailored interventions to facilitate the recovery process.
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Affiliation(s)
- Carmen Concerto
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Alessandro Rodolico
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Ludovico Mineo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Alessia Ciancio
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Leonardo Marano
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Carla Benedicta Romano
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Elisa Vita Scavo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Riccardo Spigarelli
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Rosaria Furnari
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Antonino Petralia
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Maria Salvina Signorelli
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
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22
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Gamieldien F, Galvaan R, Myers B, Sorsdahl K. Mental Health Service Users and Their Caregivers Perspectives on Personal Recovery from Severe Mental Health Conditions in Cape Town, South Africa: A Qualitative Study. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2023; 11:201-219. [PMID: 38887754 PMCID: PMC11180021 DOI: 10.1007/s40737-023-00341-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/25/2023] [Indexed: 06/20/2024]
Abstract
Severe mental health conditions (SMHCs) significantly contribute to the global disease burden. In low-and-middle-income countries (LMICs) like South Africa, the long-term impact of SMHCs on individuals and their families is serious. However, mental health services focus on clinical recovery, with little attention given to the personal recovery needs of mental health service users (MHSUs) and their caregivers. The CHIME framework outlines five domains characterising personal recovery: connectedness, hope and optimism about the future, identity, meaning in life, and empowerment. This qualitative, descriptive study sought insights from male MHSUs and their caregivers on their perspectives of personal recovery from SMHCs. Four male MHSUs and three of their caregivers were purposively selected from Cape Flats communities in the Western Cape. Data were collected using visual participatory methods, including photovoice, life graphs, community maps, and photo-elicitation interviews with MHSUs. In addition, semi-structured interviews were held with caregivers. Data were thematically analysed, and two main themes emerged: Finding meaningful participation and affirming agency. These themes describe how diverse contextual, socioeconomic, political, demographic, cultural, and spiritual factors help and hinder personal recovery. MHSUs and their caregivers sought support from mental health non-profit organisations (MH-NPOs) because of stigmatising attitudes from their communities. MH-NPOs provided MHSUs with long-term relational support and opportunities to build their capacities which helped them access living, learning, working and socialising opportunities. Understanding the diverse needs of MHSUs and including MH-NPOs in scaling up community-based mental health services in LMICs will enable more accessible services that support personal recovery.
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Affiliation(s)
- Fadia Gamieldien
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
- Inclusive Practices Africa Research Unit, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Roshan Galvaan
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
- Inclusive Practices Africa Research Unit, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
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23
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Abstract
BACKGROUND Recovery in mental illness is not synonymous with cure. Personal recovery approach consider recovery as a process and not as an outcome. This approach takes into account the subjective meaning of recovery by assessing how a person has learned to accommodate and live with an illness. AIM To study the personal meaning of recovery among persons with schizophrenia. METHOD This article presents the findings of a qualitative study about what 'recovery' means to persons with schizophrenia. A semi structured interview schedule was prepared based on literature review and expert opinion. Twenty participants who met the inclusion criteria and personally consider themselves recovering/recovered from schizophrenia were selected for the in-depth qualitative interviews. Data was analyzed using Interpretative Phenomenological Analysis (IPA). Meaning of recovery from each participant's perspective was recorded. FINDINGS The results indicate factors that patients deem important for their recovery are, absence of symptoms, regaining functioning, being able to work, having adequate emotional stability and not being on medicines. The findings are examined in the background of the previous studies and suggestions for clinical practice and research is also discussed. CONCLUSION Recovery is far more than remission of symptoms. Persons with mental illness has their own criteria of recovery, which could be very distinct from the clinical definition. Current study findings can help in identifying meaning of recovery through the perspectives of persons with mental illness and in developing and implementing recovery-oriented services.
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Affiliation(s)
- Shari Tess Mathew
- School of Social Work, St. Joseph's College (Autonomous), Bengaluru, Karnataka, India
| | - Bergai Parthsarathy Nirmala
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - John Vijay Sagar Kommu
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
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24
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Chmielowska M, Mannocci N, Tansel A, Zisman-Ilani Y. Peer support and shared decision making in Open Dialogue: Opportunities and recommendations. Front Psychol 2022; 13:1059412. [PMID: 36571005 PMCID: PMC9773137 DOI: 10.3389/fpsyg.2022.1059412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Open dialogue (OD) is a person-centred social network model of crisis and continuing mental healthcare, which promotes agency and long-term recovery in mental illness. Peer support workers who have lived experience of mental illness play a key role in OD in the UK, as they enhance shared understanding of mental health crisis as part of the OD model and provide a sense of belonging and social inclusion. These elements are in alignment with the shared decision making (SDM) approach in mental health, which focuses on person-centred communication in treatment decision-making. The previously documented benefits of peer-led SDM include increased engagement with services, symptom reduction, increased employment opportunities, and reduced utilization of mental and general health services. While the contribution of peer support and SDM principles to OD has been acknowledged, there is only a small body of literature surrounding this development, and little guidance on how peer support can enhance treatment decision-making and other aspects of OD. This viewpoint, which was co-authored by people with lived experience of mental illness, clinicians, and researchers, discusses practical implications and recommendations for research and training for the provision of a co-produced OD model grounded in peer support and SDM.
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Affiliation(s)
- Marta Chmielowska
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- North East London NHS Foundation Trust Research and Development Department, London, United Kingdom
- Division of Psychology and Language Sciences, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Nell Mannocci
- North East London NHS Foundation Trust Research and Development Department, London, United Kingdom
| | - Alexander Tansel
- North East London NHS Foundation Trust Research and Development Department, London, United Kingdom
| | - Yaara Zisman-Ilani
- Division of Psychology and Language Sciences, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, United States
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25
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Cuesta MJ, Sánchez-Torres AM, Moreno-Izco L, García de Jalón E, Gil-Berrozpe GJ, Zarzuela A, Peralta V, Ballesteros A, Fañanás L, Hernández R, Janda L, Lorente R, Papiol S, Peralta D, Ribeiro M, Rosero A, Zandio M. Neurocognitive correlates of the varied domains of outcomes at 20 year follow-up of first-episode psychosis. Psychiatry Res 2022; 318:114933. [PMID: 36334328 DOI: 10.1016/j.psychres.2022.114933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Little is known about long-term outcomes of the first episode of psychosis (FEP) other than in the symptomatic domain. We hypothesised that cognitive impairment is associated with poorer multi-domain outcomes at a long-term follow-up of FEP patients. We followed-up 172 FEP patients for a mean of 20.3 years. Ten outcome dimensions were assessed (symptomatic, functional and personal recovery, social disadvantage, physical health, suicide attempts, number of episodes, current drug use, chlorpromazine equivalent doses (CPZ), and schizophrenia/schizoaffective disorder final diagnosis). Cognition was assessed at follow-up. Processing speed and verbal memory deficits showed significant associations with poor outcomes on symptomatic, social functioning, social disadvantage, higher number of episodes, and higher CPZ. Significant associations were found between visual memory impairments were significantly associated with low symptomatic and functional recovery, between attentional deficits and a final diagnosis of schizophrenia/schizoaffective disorder, and between social cognition deficits and poor personal recovery.Lower cognitive global scores were significantly associated with all outcome dimensions except for drug abuse and physical status. Using multiple outcome dimensions allowed for the inclusion of the patients' perspective and other commonly neglected outcome measures. Taken together, cognitive impairment in FEP patients is strongly related to poor performance on several outcome dimensions beyond symptomatic remission.
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Affiliation(s)
- M J Cuesta
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - A M Sánchez-Torres
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - L Moreno-Izco
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - E García de Jalón
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - G J Gil-Berrozpe
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - A Zarzuela
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - V Peralta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - A Ballesteros
- Red de Salud Mental de Álava, Vitoria-Gasteiz, Spain
| | - L Fañanás
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain
| | - R Hernández
- CSMIJ Ciutat Vella. Consorci Parc de Salut Mar, Barcelona, Spain
| | - L Janda
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - R Lorente
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - S Papiol
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain; Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, 80336, Germany; Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - D Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - M Ribeiro
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - A Rosero
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - M Zandio
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
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26
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Green B, García-Mieres H. Construing journeys to recovery from psychosis: A qualitative analysis of first-person accounts. Psychol Psychother 2022; 95:888-904. [PMID: 35670416 DOI: 10.1111/papt.12408] [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] [Received: 11/30/2021] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To perform a qualitative analysis of the factors that were construed as salient in facilitating the process of recovery in the narratives of people with psychosis who had their first-person accounts (FPAs) published in an academic journal. METHODS Computerized textual analysis was undertaken of 156 FPAs written by persons who had experienced psychosis and published in the Schizophrenia Bulletin between 1979 and 2020. Constructs were extracted from the FPAs and coded in terms of Mental health treatment and therapy, Self-management and Multiple factors; recovery processes (Connectedness, Hope, Identity, Meaning and Empowerment), Struggles and Turning points. RESULTS Psychosis impacted on individuals in profound and diverse ways. This was reflected in the different pathways to recovery included in the FPAs. Underlying the different pathways was the salience of re-engagement in the shared reality of others; development of a cohesive and positive self; empowerment through the use of self-management strategies, and making sense of experience through reconstruing what was meaningful. Personal constructs identified in the FPAs provided insight into both challenges faced and alternative avenues of movement that were perceived as available. CONCLUSIONS Processes that support individuals re-engaging with the shared reality of others are central to recovery. Supportive relationships and fostering open dialogue were consistent themes across the different pathways that recovery journeys took. Establishing a meaningful lifestyle and recovering a positive sense of identity were a key challenge following psychosis onset. Appreciation of experiences contained in FPAs has the potential to enhance the effectiveness and humanity of mental health care.
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Affiliation(s)
- Bob Green
- Independent Scholar, Formerly Statewide Forensic Mental Health Team, Queensland Forensic Mental Health Service, Brisbane, Qld, Australia
| | - Helena García-Mieres
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions M'ediques, Barcelona, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain.,Centro Investigación Biomédica en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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27
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Rohenkohl AC, Daubmann A, Gallinat J, Karow A, Kraft V, Rühl F, Schöttle D, Lambert M, Schröter R. Health-related quality of life in severe psychotic disorders during integrated care: 5-year course, prediction and treatment implications (ACCESS II). Health Qual Life Outcomes 2022; 20:133. [PMID: 36076205 PMCID: PMC9452858 DOI: 10.1186/s12955-022-02039-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Studies on outcomes mapping Quality of Life (QoL) as patient-reported outcome over a longer period in severe psychotic disorders are scarce. However, such data would be particularly important for structuring, implementing and operating effective and efficient care models and for promoting satisfaction with care, service engagement and adherence.
Methods The ACCESS II study is a prospective long-term study of an integrated care model for people with severe psychotic disorders. The model includes Therapeutic Assertive Community Treatment within a cross-sectoral and interdisciplinary network. This publication analyses the course of QoL assessed with the Q-LES-Q-18 using a mixed model for repeated measures. Results Mapping the course of QoL in N = 329 participants, there is a significant increase in the first 6 weeks of treatment (early course). Comparison to a published norm show significant lower QoL for severe psychotic disorders. The variable having a traumatic event before the age of 18 was significantly negatively associated with QoL. A decrease in the severity of depressive as well as in positive symptomatology in the first six weeks after admission was associated with increase of QoL. Conclusion Results indicate that the overall symptom burden at time of inclusion is not decisive for the perceived QoL in the long-term course while the reduction in the severity of depressive and positive symptoms is important. This means focusing even more on the treatment of depressive symptoms and include traumatherapeutic aspects in the long-term treatment of severe psychotic disorders if needed.
Trail registration ClinicalTrials.gov (identifier: NCT01888627).
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Affiliation(s)
- Anja Christine Rohenkohl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany.
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Vivien Kraft
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Friederike Rühl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Romy Schröter
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
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28
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Goodman-Casanova JM, Cuesta-Lozano D, Garcia-Gallardo M, Duran-Jimenez FJ, Mayoral-Cleries F, Guzman-Parra J. Measuring mental health recovery: Cross-cultural adaptation of the 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP). Int J Ment Health Nurs 2022; 31:650-664. [PMID: 35277913 PMCID: PMC9314871 DOI: 10.1111/inm.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
Mental health services need reliable and valid instruments to measure mental health recovery outcomes, and the only available one in Spanish is arduous. Adapting an instrument is more efficient than creating a new one as it enables international comparison research. The aim of this study was to conduct a cross-cultural adaptation of the 15-item Questionnaire about the Process of Recovery. Fifty-four participants engaged in a five-stage systematic and standardized process carried out from November 2019 to November 2020. Professional translators (n = 4) from the Translation Service Center for Foreign Languages of the Universidad de Alcalá participated in the direct translation, synthesis and back translation stages, and mental health professionals (n = 33) and service users (n = 17) from the Hospital Regional Universitario de Málaga and the Hospital Universitario Virgen de la Victoria in Andalucía (Spain), with an average of 19.2 (SD 12.86) years of experience in mental health, participated in the committee of experts and pilot debriefing stages. Additionally, legibility was assessed. Out of the 15-items of the questionnaire, three (20%) were equal amongst translations, three items (20%) of the back translations matched the original questionnaire and discrepancies identified were adapted accordingly. Seven items (46.7%) were approved online by experts and consensus of alternative translations was reached for the rest. The average time spent completing the questionnaire by service users during the face-to-face pilot was 4.12 min (SD 2.25). Internal consistency obtained was ω = 0.95 and α = 0.91. Debriefing findings reported the questionnaire as comprehensible (97.1%), adequate in wording (91.2%), formal in language (55.9%) and adequate in terms of length (100%). The questionnaire scored 65.53, 'normal' readability, on the Inflesz scale. The adapted instrument has conceptual, linguistic, cultural and metric equivalence to the original instrument.
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Affiliation(s)
- Jessica Marian Goodman-Casanova
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Departamento de Enfermería y Fisioterapia, Universidad de Alcalá, Madrid, Spain
| | | | - Marta Garcia-Gallardo
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Francisco Javier Duran-Jimenez
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Fermin Mayoral-Cleries
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Jose Guzman-Parra
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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29
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Segeren M, Lauriks S, Kikkert M, Heering J, Lommerse N, van Husen G, Verhoeff A. Deinstitutionalization from the perspective of community-dwelling adults with a severe mental illness in Amsterdam: a cohort study protocol. BMC Public Health 2022; 22:950. [PMID: 35549681 PMCID: PMC9097409 DOI: 10.1186/s12889-022-13291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background People with a severe mental illness (SMI) increasingly receive ambulatory forms of care and support. The trend of deinstitutionalization accelerated in the Netherlands from 2008 and onwards without sufficient understanding of its consequences. The study protocol herein focuses on deinstitutionalization from the perspective of adults with an SMI living within the community in Amsterdam and aims at delivering better insight into, amongst others, their recovery, quality of life, societal participation and needs for care and support. Methods A cohort design will be used. A representative sample of community-dwelling adults with an SMI, including those in care (n = 650) and not in care (n = 150), will be followed over time. During a two-year time period, participants will be interviewed twice using a wide-ranging set of validated instruments. Interview data will be matched with administrative data about the care process, as retrieved from their patient files. Primary outcomes are changes over time in recovery, societal participation and quality of life, controlled for the occurrence of adverse life-events during follow-up. Additionally, prevalence estimates of and associations between social functioning, safety and discrimination, substance use and health indicators will be investigated. Discussion The study protocol aims at delivering a comprehensive insight into the needs of community-dwelling adults with an SMI based on which ambulatory care and support can best be provided to optimally promote their social recovery and well-being.
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Affiliation(s)
- Menno Segeren
- Public Health Service Amsterdam, Department of Epidemiology, Health Promotion and Care Innovation, Amsterdam, the Netherlands.
| | - Steve Lauriks
- Public Health Service Amsterdam, Department of Epidemiology, Health Promotion and Care Innovation, Amsterdam, the Netherlands
| | - Martijn Kikkert
- Department of Research, Arkin Mental Health Care Institute, Amsterdam, the Netherlands
| | - Jet Heering
- GGZ inGeest, Department of Research & Innovation, Amsterdam, the Netherlands
| | - Nick Lommerse
- Department of Research, Arkin Mental Health Care Institute, Amsterdam, the Netherlands
| | - Gwen van Husen
- Public Health Service Amsterdam, Department of Epidemiology, Health Promotion and Care Innovation, Amsterdam, the Netherlands
| | - Arnoud Verhoeff
- Public Health Service Amsterdam, Department of Epidemiology, Health Promotion and Care Innovation, Amsterdam, the Netherlands.,Department of Sociology, University of Amsterdam, Amsterdam, the Netherlands
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30
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Peralta V, García de Jalón E, Moreno-Izco L, Peralta D, Janda L, Sánchez-Torres AM, Cuesta MJ. Long-Term Outcomes of First-Admission Psychosis: A Naturalistic 21-Year Follow-Up Study of Symptomatic, Functional and Personal Recovery and Their Baseline Predictors. Schizophr Bull 2022; 48:631-642. [PMID: 34999894 PMCID: PMC9077430 DOI: 10.1093/schbul/sbab145] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study was aimed at characterizing long-term outcomes of first-admission psychosis and examining their baseline predictors. Participants were assessed at baseline for 38 candidate predictors and re-assessed after a median follow-up of 21 years for symptomatic, functional, and personal recovery. Associations between the predictors and the outcomes were examined using univariate and multivariate Cox regression models. At baseline, 623 subjects were assessed for eligibility, 510 met the inclusion/exclusion criteria and 243 were successfully followed-up (57.3% of the survivors). At follow-up, the percentages of subjects achieving symptomatic, functional, and personal recovery were 51.9%, 52.7%, and 51.9%, respectively; 74.2% met at least one recovery criterion and 32.5% met all three recovery criteria. Univariate analysis showed that outcomes were predicted by a broad range of variables, including sociodemographics, familial risk, early risk factors, premorbid functioning, triggering factors, illness-onset features, neurological abnormalities, deficit symptoms and early response to treatment. Many of the univariate predictors became nonsignificant when entered into a hierarchical multivariate model, indicating a substantial degree of interdependence. Each single outcome component was independently predicted by parental socioeconomic status, family history of schizophrenia spectrum disorders, early developmental delay, childhood adversity, and mild drug use. Spontaneous dyskinesia/parkinsonism, neurological soft signs and completion of high school remained specific predictors of symptomatic, functional, and personal outcomes, respectively. Predictors explained between 27.5% and 34.3% of the variance in the outcomes. In conclusion, our results indicate a strong potential for background and first-episode characteristics in predicting long-term outcomes of psychotic disorders, which may inform future intervention research.
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Affiliation(s)
- Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Elena García de Jalón
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Lucía Moreno-Izco
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - David Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Lucía Janda
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Manuel J Cuesta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
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31
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Watanabe S, Taniguchi T, Sugihara M. Relationship between social function and personal recovery in patients with schizophrenia. Asian J Psychiatr 2022; 71:103078. [PMID: 35305450 DOI: 10.1016/j.ajp.2022.103078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Seiichi Watanabe
- Department of Occupational Therapy, Medical Corporation Nasukougen Hospital, Nasu-machi, Tochigi, Japan; Division of Occupational Therapy, Doctoral Program in Health Sciences, Graduate School of Health and Welfare Sciences, Ohtawara, Tochigi, Japan.
| | - Takamichi Taniguchi
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Ohtawara, Tochigi, Japan.
| | - Motoko Sugihara
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato-ku, Tokyo, Japan.
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Shikuri Y, Tanoue H, Imai H, Nakamura H, Yamaguchi F, Goto T, Kido Y, Tajika A, Sawada H, Ishida Y, Yoshinaga N. Psychosocial interventions for community-dwelling individuals with schizophrenia: study protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e057286. [PMID: 35487709 PMCID: PMC9058762 DOI: 10.1136/bmjopen-2021-057286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Despite the recent global mental health movement of the transition from hospital-centred to integrated community-based services, comprehensive evidence of psychosocial interventions focusing on community-dwelling individuals with schizophrenia is still lacking. To overcome this gap in the current knowledge, we will conduct a systematic review and meta-analysis to assess the efficacy of all types of psychosocial interventions for community-dwelling (non-hospitalised) individuals with schizophrenia when compared with non-active control conditions (eg, treatment as usual). METHODS AND ANALYSIS This study protocol has been developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. By March 2022, the following sources will have been searched, without restrictions for language or publication period: Embase, PubMed, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. We will also try to identify other potentially eligible studies by searching the reference lists of included studies, other relevant systematic reviews and grey literature. All relevant randomised controlled trials from both high-income and low-income to middle-income countries will be allowed. Two independent reviewers will conduct the selection/screening of studies, data extraction and methodological quality assessment of included studies. The primary outcomes are quality of life and psychiatric hospital admission. Standard pairwise meta-analyses with a random-effects model will be conducted. Subgroup and sensitivity analyses will be performed to assess the robustness of the findings. Risk of bias will be assessed with the Revised Cochrane Risk-of-Bias Tool for Randomised Trials. The Grades of Recommendation Assessment, Development and Evaluation approach will be used to assess the quality of evidence. ETHICS AND DISSEMINATION Ethics approval is not required for this study. The study findings will be disseminated through conference presentations as well as peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42021266187.
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Affiliation(s)
- Yuki Shikuri
- Graduate School of Nursing Science, University of Miyazaki, Miyazaki, Japan
| | - Hiroki Tanoue
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Hideki Nakamura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Fumitake Yamaguchi
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Taichi Goto
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Yoshifumi Kido
- Faculty of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Hirotake Sawada
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yasushi Ishida
- Division of Psychiatry, Department of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Hurmuz M, Frandes M, Panfil AL, Stoica IP, Bredicean C, Giurgi-Oncu C, Papava I, Nirestean A. Quality of Life in Patients with Chronic Psychotic Disorders: A Practical Model for Interventions in Romanian Mental Health Centers. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:615. [PMID: 35630032 PMCID: PMC9143751 DOI: 10.3390/medicina58050615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
Background and Objectives: Current psychiatric care is increasingly focusing on patients' quality of life (QoL). Research is still trying to determine the main factors which influence QoL. The present study aims to assess the QoL of patients with chronic psychotic-spectrum disorders, as well as its relation to symptomatology, functionality, adaptive behavior, and perceived level of recovery. Materials and Methods: The study included a sample of 78 patients with chronic psychosis. Symptomatology and illness severity were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale-Severity (CGI-S) scales, respectively. The Global Assessment of Functioning Scale (GAFS) and the Adaptive Behavior Assessment System II (ABAS-II)-Adult Form were used for the assessment of patients' functionality, and the Quality-of-Life Inventory (QOLI) scale was applied for the evaluation of QoL. Results: According to the CGI-Severity scale, 20.5% of the patients were borderline mentally ill, and 24.4% were mildly ill. The highest number of patients (34.6%) were moderately ill, while 14.1% and 2.6% were markedly ill and severely ill, respectively. Among the moderately ill patients, more than half (63%) were patients with schizophrenia, 18.5% were patients with delusional disorder, and 18.5% were patients with schizoaffective disorder. Most of the patients (43.6%) presented moderate functioning deficiency, while 38.5% of the patients presented severe deficiency, according to the GAFS score. When assessed with the ABAS, we observed that almost half of the patients (44.9%) showed an average functioning across skill areas in the conceptual, social, and practical domains. A percent of 67.9% of the patients presented an average QoL, while 15.4% and 12.8% showed a very low and low QoL. QoL was not influenced by the patients' symptomatology, gender, and education level. Having children, family support, better social and conceptual skills, and a higher perceived level of recovery was correlated with an increased QoL, hierarchical multiple regression R2 = 0.379, F(9, 68) = 2.616, and p = 0.012. Conclusions: Psychiatric interventions in psychosis should focus not only on symptoms' control, but also on improving social and family support, as well as adaptive skills to increase the patients' QoL.
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Affiliation(s)
- Marinela Hurmuz
- Discipline of Psychiatry, Department of Clinical Sciences, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Str. G. Marinescu, 540139 Targu Mures, Romania; (M.H.); (A.N.)
- Mental Health Center No. 1, “Pius Branzeu” Timis County Emergency Clinical Hospital, 156 Bd. Liviu Rebreanu, 300182 Timisoara, Romania;
| | - Mirela Frandes
- Department of Functional Sciences—Medical Informatics and Biostatistics, “Victor Babes” University of Medicine and Pharmacy, 2 Sq. Eftimie Murgu, 300041 Timisoara, Romania
| | - Anca-Livia Panfil
- Liaison Psychiatry Department, “Pius Branzeu” Timis County Emergency Clinical Hospital, 156 Bd. Liviu Rebreanu, 300182 Timisoara, Romania;
| | - Ileana-Pepita Stoica
- Mental Health Center No. 1, “Pius Branzeu” Timis County Emergency Clinical Hospital, 156 Bd. Liviu Rebreanu, 300182 Timisoara, Romania;
| | - Cristina Bredicean
- Department of Neuroscience, NEUROPSY-COG Center for Cognitive Research in Neuropsychiatric Pathology, “Victor Babes” University of Medicine and Pharmacy, 2 Sq. Eftimie Murgu, 300041 Timisoara, Romania; (C.B.); (C.G.-O.); (I.P.)
- “Dr. Victor Popescu” Emergency Military Clinical Hospital, 7 Str. G. Lazăr, 300080 Timisoara, Romania
| | - Catalina Giurgi-Oncu
- Department of Neuroscience, NEUROPSY-COG Center for Cognitive Research in Neuropsychiatric Pathology, “Victor Babes” University of Medicine and Pharmacy, 2 Sq. Eftimie Murgu, 300041 Timisoara, Romania; (C.B.); (C.G.-O.); (I.P.)
- “Eduard Pamfil” Psychiatric Clinic, “Pius Branzeu” Timis County Emergency Clinical Hospital, 156 Bd. Liviu Rebreanu, 300182 Timisoara, Romania
| | - Ion Papava
- Department of Neuroscience, NEUROPSY-COG Center for Cognitive Research in Neuropsychiatric Pathology, “Victor Babes” University of Medicine and Pharmacy, 2 Sq. Eftimie Murgu, 300041 Timisoara, Romania; (C.B.); (C.G.-O.); (I.P.)
- “Eduard Pamfil” Psychiatric Clinic, “Pius Branzeu” Timis County Emergency Clinical Hospital, 156 Bd. Liviu Rebreanu, 300182 Timisoara, Romania
| | - Aurel Nirestean
- Discipline of Psychiatry, Department of Clinical Sciences, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Str. G. Marinescu, 540139 Targu Mures, Romania; (M.H.); (A.N.)
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Gooding PA, Harris K, Haddock G. Psychological Resilience to Suicidal Experiences in People with Non-Affective Psychosis: A Position Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073813. [PMID: 35409502 PMCID: PMC8997645 DOI: 10.3390/ijerph19073813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 03/02/2022] [Indexed: 01/03/2023]
Abstract
It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of resilience to suicidal thoughts and acts in people with severe mental health problems, specifically non-affective psychosis, was the overarching aim of this position paper. There are five central suggestions: 1. investigating resilience to suicidal experiences has been somewhat over-looked, especially in those with severe mental health problems such as schizophrenia; 2. it appears maximally enlightening to use convergent qualitative, quantitative and mixed research methods to develop a comprehensive understanding of resilience to suicide; 3. relatedly, involving experts-by-experience (consumers) in suicide research in general is vital, and this includes research endeavours with a focus on resilience to suicide; 4. evidence-based models of resilience which hold the most promise appear to be buffering, recovery and maintenance approaches; and 5. there is vast potential for contemporary psychological therapies to develop and scaffold work with clients centred on building and maintaining resilience to suicidal thoughts and acts based on different methodological and analytical approaches which involve both talking and non-talking approaches.
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Affiliation(s)
- Patricia A. Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, UK; (P.A.G.); (G.H.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
| | - Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, UK; (P.A.G.); (G.H.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
- Correspondence:
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, UK; (P.A.G.); (G.H.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
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Lawlor C, Vitoratou S, Duffy J, Cooper B, De Souza T, Le Boutillier C, Carter B, Hepworth C, Jolley S. Managing emotions in psychosis: Evaluation of a brief DBT-informed skill group for individuals with psychosis in routine community services. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:735-756. [PMID: 35130354 PMCID: PMC9543194 DOI: 10.1111/bjc.12359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/19/2022] [Indexed: 12/02/2022]
Abstract
Objectives Individuals with psychosis report that emotion regulation (ER) difficulties are treatment priorities, yet little is known about how targeted ER interventions may help. We evaluated a new eight‐session Dialectical Behavioural Therapy (DBT)–informed skills group specifically adapted for individuals with psychosis: the Managing Emotions Group (MEG) in diverse, inner‐city community services. Method A mixed‐method design was utilised to assess the feasibility (acceptability and potential clinical impact) of local delivery of MEG. Uptake, completion (≥50% of sessions), post‐session satisfaction ratings, and thematic analysis of qualitative feedback from 12 completers assessed acceptability. Pre–post‐intervention changes in psychological distress, self‐reported ER difficulties, and adaptive ER skill use assessed potential clinical impact. Results Forty‐eight individuals (81% of attenders) completed the intervention (Mage = 43, 54% female) of whom 39 completed pre‐ and post‐group measures. Participants reported high satisfaction and meaningful improvements in understanding and managing emotions, with positive impact on daily life. Self‐reported psychological distress, ER difficulties, and adaptive ER skill use significantly improved, with medium‐to‐large pre‐post effects (d = 0.5–0.7) except lack of emotional clarity (d = 0.3). Conclusions MEG was feasible and acceptable, and a future feasibility randomised controlled trial is warranted. Practitioner points Individuals with psychosis report that support with their emotions is a priority. Brief interventions for emotion regulation difficulties are acceptable to individuals with psychosis and can be feasibly delivered in a local outpatient service. Distress and emotion regulation difficulties and skills improved significantly from pre–post treatment for clients completing the managing emotions group. Further implementation and evaluation are needed to support continued refinement to meet the needs and priorities of individuals with psychosis.
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Affiliation(s)
- Caroline Lawlor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Duffy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Cooper
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Clair Le Boutillier
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ben Carter
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Chirio-Espitalier M, Schreck B, Duval M, Hardouin JB, Moret L, Bronnec MG. Exploring the Personal Recovery Construct in Bipolar Disorders: Definition, Usage and Measurement. A Systematic Review. Front Psychiatry 2022; 13:876761. [PMID: 35815013 PMCID: PMC9263970 DOI: 10.3389/fpsyt.2022.876761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Personal recovery from psychiatric disorders is a journey toward a satisfying and hopeful life despite the possible persistence of symptoms. This concept has gained interest and become an increasingly important goal in mental health care programmes. Personal Recovery is well described in the context of severe mental illnesses in general, but little is known about this journey in bipolar disorders and the factors underlying it. A systematic review was conducted according to the PRISMA recommendations, focusing on studies exploring personal recovery in bipolar disorder specifically. The latter have integrated a comprehensive approach to the concept, the existing means of measurement or have explored the levers of recovery in care. Twenty-four articles were selected, including seven qualitative, 12 observational, and five interventional studies. The Bipolar Recovery Questionnaire was the only scale developed de novo from qualitative work with bipolar people. Personal recovery did not correlate very closely with symptomatology. Some elements of personal recovery in bipolar disorder were similar to those in other severe mental illnesses: meaning in life, self-determination, hope, and low self-stigma. Specific levers differed: mental relationships with mood swings, including acceptance and decrease in hypervigilance, and openness to others, including trust and closeness. The studies highlighted the role of caregiver posture and the quality of communication within care, as well as the knowledge gained from peers. The choice to exclude articles not focused on bipolar disorder resulted in the provision of very specific information, and the small number of articles to date may limit the scope of the evidence. New components of personal recovery in bipolar disorder emerged from this review; these components could be taken into account in the construction of care tools, as well as in the caregiving posture. Strengthening skills of openness to others could also be a central target of recovery-focused care.
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Affiliation(s)
- Marion Chirio-Espitalier
- Nantes University, CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes, France.,Nantes University, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
| | - Benoit Schreck
- Nantes University, CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes, France.,Nantes University, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
| | - Melanie Duval
- Department of Public Health, University Hospital of Nantes, Nantes, France
| | - Jean-Benoit Hardouin
- Nantes University, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
| | - Leila Moret
- Nantes University, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France.,Department of Public Health, University Hospital of Nantes, Nantes, France
| | - Marie Grall Bronnec
- Nantes University, CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes, France.,Nantes University, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
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37
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Ow N, Marchand K, Glowacki K, Alqutub D, Mathias S, Barbic SP. YESS: A feasibility study of a supported employment program for youths with mental health disorders. Front Psychiatry 2022; 13:856905. [PMID: 36213923 PMCID: PMC9543261 DOI: 10.3389/fpsyt.2022.856905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE In Canada, employment/education support is rarely embedded as a component of mental health service delivery. This study describes a supported education/employment program (SEP) that integrates both clinical and community mental health services. The main objectives were to estimate the feasibility of a 5-week SEP among youths aged 17-24 with mental illness and to estimate the extent to which participation in this program improved employment and mental health outcomes. METHODS This was a single cohort study. Feasibility outcomes assessed were demand, acceptability, practicality, integration, adaptation, and effectiveness. These were assessed through recruitment and retention rates, recording patterns of missing data, and examining differences between completers and non-completers. Appropriateness of the outcome measures was assessed through the strength of the association between the outcome measures at baseline. Effectiveness of the program was assessed through employment and as measured using MyLifetracker (MLT), Satisfaction with Life Scale (SWLS), and the Canadian Personal Recovery Outcome Measure (CPROM). RESULTS A total of 110 youths with a mean age of 20.6 (SD: 2.2) were recruited. At 5 weeks, 82 (74.5%) of participants remained in the program. Of the people who completed the program, 56.1% were women, 76.6% were in stable housing and 64.1% had depression. Approximately 60% of non-completers used two or more services and were in at-risk housing. More than 25% of participants improved on the patient-reported outcomes. Scores on these measures were moderately to highly correlated with each other. Employment rates varied and corresponded to the waves of the COVID-19 pandemic in Canada. CONCLUSION Results showed that this program was feasible and there was high demand for SEP during the COVID-19 pandemic but gaining employment remained difficult. Educational or employment outcomes, measured over a short period, may not be adequate. Instead, individualized and patient-reported outcome measures may be more appropriate for SEP programs.
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Affiliation(s)
- Nikki Ow
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Kirsten Marchand
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Foundry Central Office, Vancouver, BC, Canada
| | - Krista Glowacki
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Foundry Central Office, Vancouver, BC, Canada
| | | | - Steve Mathias
- Foundry Central Office, Vancouver, BC, Canada.,Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Skye P Barbic
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Foundry Central Office, Vancouver, BC, Canada
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38
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Leendertse P, Hirzalla F, van den Berg D, Castelein S, Mulder CL. Facilitating and hindering factors of personal recovery in the context of Soteria-A qualitative study among people with (early episode) psychosis. Front Psychiatry 2022; 13:1051446. [PMID: 36683984 PMCID: PMC9848445 DOI: 10.3389/fpsyt.2022.1051446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The objective of this study was to gain insight into patients' experiences of how personal recovery (PR) is facilitated or hindered in the context of an early episode psychosis setting (Soteria). We thereby aimed to contribute to the understanding of how care settings may promote or hinder the process of PR in people with (acute) psychosis. METHOD This study used a qualitative method, consisting of semi-structured in-depth interviews with people who had been admitted to a Soteria house in the Netherlands. Interview transcripts were analyzed following the Grounded Theory approach. RESULTS Five themes emerged from the data illustrating how Soteria facilitated or impeded PR. The experience of togetherness in contact with staff and peers, feeling at home, and being active facilitated PR, while the emphasis put on medication by staff was experienced as hindering, and attention to spirituality was missed. CONCLUSION In addition to the literature that identified factors associated with PR in psychosis, the current study gives a sense of how this can be put into practice. By offering treatment within a normalizing, holding environment, with emphasis on equality, close contact, optimism, active structured days, open-mindedness toward spirituality, and the role of medication, PR can be facilitated without detracting from guideline-based treatment aimed at symptomatic recovery. Similarities with existing concepts are discussed.
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Affiliation(s)
- Pien Leendertse
- Emergis, Institute for Mental Healthcare, Kloetinge, Netherlands.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Fadi Hirzalla
- Department of Public Administration and Sociology, Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, Netherlands
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Stynke Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, Netherlands.,Faculty of Behavioral and Social Sciences, Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Cornelis Lambert Mulder
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands.,Antes, Institute for Mental Healthcare, Parnassia Psychiatric Institute, Rotterdam, Netherlands
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39
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van Sambeek N, Baart A, Franssen G, van Geelen S, Scheepers F. Recovering Context in Psychiatry: What Contextual Analysis of Service Users' Narratives Can Teach About Recovery Support. Front Psychiatry 2021; 12:773856. [PMID: 34987427 PMCID: PMC8720875 DOI: 10.3389/fpsyt.2021.773856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Aim: Enhancement of recovery-oriented care in psychiatry requires insight into the personal meaning and context of recovery. The Psychiatry Story Bank is a narrative project, designed to meet this need, by collecting, sharing and studying the narratives of service-users in psychiatry. Our study was aimed at expanding insight into personal recovery through contextual analysis of these first-person narratives. Methods: We analyzed 25 narratives, as collected through research interviews. To capture the storied context on both a personal, interpersonal and ideological level we combined several forms of qualitative analysis. A total of 15 narrative characteristics were mapped and compared. Results: Through comparative analysis we identified four narratives genres in our sample: Lamentation (narratives about social loss), Reconstruction (narratives about the impact of psychosis), Accusation (narratives about injustice in care), and Travelogue (narratives about identity transformation). Each genre provides insight into context-bound difficulties and openings for recovery and recovery-support. Conclusion: A contextual approach to studying personal recovery offers insights that can help attune recovery support in psychiatry. Important clues for recovery support can be found in people's narrated core struggle and the associated desire to be recognized in a particular way. Our results also indicate that familiarity with different ways of understanding mental distress, can help people to express and reframe their struggles and desires in a helpful way, thereby facilitating recognition.
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Affiliation(s)
- Nienke van Sambeek
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Andries Baart
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Humanities, Optentia Research Unit Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Gaston Franssen
- Department of Dutch Literary Studies, Faculty of Humanities, University of Amsterdam, Amsterdam, Netherlands
| | | | - Floortje Scheepers
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
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40
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Slade M. Management of a High-Performing Mental Health Recovery Research Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4007. [PMID: 33920382 PMCID: PMC8070016 DOI: 10.3390/ijerph18084007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022]
Abstract
A personal perspective is given on the processes involved in managing and sustaining a high-performing mental health recovery research group. The broader context of scholarship in the United Kingdom is outlined, in which academic productivity is commodified specifically in relation to peer-reviewed journal papers. Four leadership choices in developing a high-performing research group are discussed: optimal group size; sharing the workload; maintaining a programmatic focus; and performance expectations. Approaches to maximising innovation are identified, including emotional and intellectual engagement of team members, working with diverse stakeholders and convening communities of practice. We use a highly managed approach to publications from inception to acceptance, which is described in detail. The use of these approaches is illustrated in relation to the Recovery Research Team which was formed in 2009. Specific recovery-related issues covered include demonstrating the ability to develop a significant recovery research portfolio (our four current large [>UK£2 m] studies relate to recovery narratives, global mental health peer support work, digital interventions and Recovery Colleges); the positive implications of actively recruiting researchers with mental health lived experience; how performance issues are managed; our approach to involving lived experience co-authors in papers; and our decision to conduct mixed-methods rather than solely qualitative studies.
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Affiliation(s)
- Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK
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41
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Kaminskiy E, Zisman-Ilani Y, Morant N, Ramon S. Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views. Front Psychiatry 2021; 12:678005. [PMID: 34220584 PMCID: PMC8245843 DOI: 10.3389/fpsyt.2021.678005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions.
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Affiliation(s)
- Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States.,Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Nicola Morant
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Shulamit Ramon
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
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42
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Alvarez-Mon MA, Donat-Vargas C, Santoma-Vilaclara J, de Anta L, Goena J, Sanchez-Bayona R, Mora F, Ortega MA, Lahera G, Rodriguez-Jimenez R, Quintero J, Álvarez-Mon M. Assessment of Antipsychotic Medications on Social Media: Machine Learning Study. Front Psychiatry 2021; 12:737684. [PMID: 34867531 PMCID: PMC8637121 DOI: 10.3389/fpsyt.2021.737684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Antipsychotic medications are the first-line treatment for schizophrenia. However, non-adherence is frequent despite its negative impact on the course of the illness. In response, we aimed to investigate social media posts about antipsychotics to better understand the online environment in this regard. Methods: We collected tweets containing mentions of antipsychotic medications posted between January 1st 2019 and October 31st 2020. The content of each tweet and the characteristics of the users were analyzed as well as the number of retweets and likes generated. Results: Twitter users, especially those identified as patients, showed an interest in antipsychotic medications, mainly focusing on the topics of sexual dysfunction and sedation. Interestingly, paliperidone, despite being among one of the newest antipsychotics, accounted for a low number of tweets and did not generate much interest. Conversely, retweet and like ratios were higher in those tweets asking for or offering help, in those posted by institutions and in those mentioning cognitive complaints. Moreover, health professionals did not have a strong presence in tweet postings, nor did medical institutions. Finally, trivialization was frequently observed. Conclusion: This analysis of tweets about antipsychotic medications provides insights into experiences and opinions related to this treatment. Twitter user perspectives therefore constitute a valuable input that may help to improve clinicians' knowledge of antipsychotic medications and their communication with patients regarding this treatment.
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Affiliation(s)
- Miguel A Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.,Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Carolina Donat-Vargas
- Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | | | - Laura de Anta
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Javier Goena
- Department of Psychiatry and Clinical Psychology, University of Navarra Clinic, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Rodrigo Sanchez-Bayona
- Hospital Universitario 12 de Octubre, Unidad de Cáncer de Mama y Ginecológico, Madrid, Spain
| | - Fernando Mora
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain.,Department of Legal and Psychiatry, Complutense University, Madrid, Spain
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.,Department of Psychiatry, University Hospital Principe de Asturias, Alcalá de Henares, Spain.,CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
| | - Roberto Rodriguez-Jimenez
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas 12), Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Javier Quintero
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain.,Department of Legal and Psychiatry, Complutense University, Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.,Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias (CIBEREHD), Alcalá de Henares, Spain
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