Recovery from psychosis: What factors are important

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Recovery from psychosis: What factors are important

  1. 1. Recovery from Psychosis: What Factors are Important? Fleur-Michelle CoiffaitMonday, 14 May 2012
  2. 2. OverviewMonday, 14 May 2012
  3. 3. Overview • Recovery FactorsMonday, 14 May 2012
  4. 4. Overview • Recovery Factors • Implications for Further ResearchMonday, 14 May 2012
  5. 5. Overview • Recovery Factors • Implications for Further Research • Limitations of this ReviewMonday, 14 May 2012
  6. 6. Overview • Recovery Factors • Implications for Further Research • Limitations of this Review • ReferencesMonday, 14 May 2012
  7. 7. Factors associated with recovery,Monday, 14 May 2012
  8. 8. Economic & Vocational Factors • Supported employment leading evidence-based intervention for those with established mental illness • Employment can enhance social participation, inclusion, functional outcome (Killackey et al., 2006) • Access to mental health servicesMonday, 14 May 2012
  9. 9. Social Factors • Those who had experienced psychosis reported that social networks provided security and stability, more so than family • Friends’ validation of them and their experience was also identified as an important part of recovery (Tooth et al., 2003)Monday, 14 May 2012
  10. 10. Family Relationships & Attachment • Berry et al. (2007) review of role of adult attachment style in psychosis • Greater security associated with better compliance with treatment • Clinician’s attachment style a recovery factorMonday, 14 May 2012
  11. 11. Cultural Factors • WHO study (1979) • Recovery rate twice as high in developing countries than industrial countries • Findings replicated (Jablensky et al., 1992) • Socially oriented approach to healing, inclusion, community connectionsMonday, 14 May 2012
  12. 12. Supportive Therapy • Quality of therapeutic alliance key determinant of outcome (Tatton & Tarrier, 2000) • Engaging service-user important for effective communication • Collaborative approachMonday, 14 May 2012
  13. 13. Consumer-focused Treatment • Service users commonly report that they ‘recovered in spite of and despite access to services’ • Need to move away from maintenance, monitoring, symptom management and relapse prevention • Objective expert vs subjective personal experience (Glover, 2005)Monday, 14 May 2012
  14. 14. Early Intervention • Consistent relationship between duration of untreated psychosis and outcome (Killackey & Yung, 2007) • 3 year follow-up of RCT, cognitive therapy reduced likelihood of being prescribed anti-psychotic medication • Significantly reduced likelihood of progression to psychosis as defined using PANSS (Morrison et al., 2006)Monday, 14 May 2012
  15. 15. Medication & Side Effects • Regular monitoring of medication (NICE Guidelines, 2003) • Potential for disengagement • Encourage choice, offer range of alternatives • Emphasis on use as a tool to facilitate psychosocial interventionsMonday, 14 May 2012
  16. 16. Other Internal Factors • Hope, belief in recovery • Enjoyment of life • Self-esteem • Sprituality (Stewart, 2003; Dorrer, 2006)Monday, 14 May 2012
  17. 17. Summary of Factors Important in Recovery • Social & Cultural factors • Economic & Vocational factors • Family Relationships & Attachment • Supportive Therapy & Consumer-focused Treatment • Early Intervention • Medication & Side Effects • Other Internal FactorsMonday, 14 May 2012
  18. 18. Implications for Further Research • Issue of defining recovery – subjective process, personal meaning • Goodness of fit – issue of how recovery is measured, traditional outcome measures may not tap into recovery • Draw upon experience of those who have recovered from psychosisMonday, 14 May 2012
  19. 19. Limitations of this Review • Brief overview of only a selection of publications in the literature • Ideally, systematic, comprehensive review of relevant peer-reviewed literature • Exploration of methodological issues • Not possible due to time constraints and unfamiliarity with this fieldMonday, 14 May 2012
  20. 20. References • Berry, A., Barrowclough, C., Wearden, A. (2007). A review of the role of adult attachment style in psychosis: Unexplored issues and questions for further research. • Cooper, B. (2006). Immigration and schizophrenia: The social causation hypothesis revisited. The British Journal of Psychiatry , 186, 361-363. • Dorrer, N. (2006). Evidence of Recovery: The ‘Ups’ and ‘Downs’ of Longitudinal Outcome Studies. SRN Discussion Paper Series. Report No.4. Glasgow, Scottish Recovery Network. • Glover, H. (2005). Recovery based service delivery: are we ready to transform the words into a paradigm shift? Australian e-Journal for the Advancement of Mental Health, 4, 3. • Jablensky, A., Sartorius, N., Ernberg, G., Anker, M., Korten, A., Cooper, J.E., Day, R., & Bertelsen, A. (1992). Schizophrenia: Manifestations, incidence and course in different cultures, a World Health Organization ten-country study. Cambridge: Cambridge University Press. • Killackey, E.J., Jackson, H.J., Gleeson, J., Hickie, I.B., & McGorry, P.D. (2006). Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first-episode psychosis: Employing cautious optimism. Australian and New Zealand Journal of Psychiatry, 40, 951–962. • Killackey, E.J., & Yung, A.R. (2007). Effectiveness of early intervention in psychosis. Current Opinion in Psychiatry, 20, 121–125.Monday, 14 May 2012
  21. 21. References • Liberman, R.P., & Kopelowicz, A. (2002). Recovery from schizophrenia: A challenge for the 21st century. International Review of Psychiatry, 14, 4, 245-255. • Morrison, A.P., French, P., Parker, S., Roberts, M. Stevens, H., Bentall, R.P., & Lewis, S.W. (2006). Three- year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk. Schizophrenia Bulletin, 33, 3, 682–687. • National Institute for Clinical Excellence (2003). Schizophrenia: Full national clinical guideline on core interventions in primary and secondary care. London: NICE. http:// www.nice.org.uk/guidance/CG1 [accessed 09/10/2007] • Stewart, E. (2003). The Ohio consumer’s Outcome Initiative: the relationship between empowerment and symptom distress. International Association of Psychosocial Rehabilitation Services Conference, Atlanta, USA. • Tattan, T., & Tarrier, N. (2000). The expressed emotion of case managers of the seriously mentally ill: The influence of expressed emotion on clinical outcomes. Psychological Medicine, 30, 195−204. • Tooth, B., Kalyanasundaram, V., Glover , H., & Momenzadah, S. (2003). Factors consumers identify as important to recovery from schizophrenia. Australasian Psychiatry, 11 (Supplement), 70-77. • World Health Organisation (1979). Schizophrenia: an international follow-up study. New York: Wiley.Monday, 14 May 2012

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