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Summary Week 2 - Severe Mental Illness in Urban Context
- Instelling
- Erasmus Universiteit Rotterdam (EUR)
Summary of the Literature for Week 2 - Severe Mental Illness in Urban Context
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Voorbeeld van de inhoud
Module 2: Complex, Comorbid, and Chronic DisordersClinical, Societal, and Personal Recovery in
Schizophrenia Spectrum Disorders Across
Time: States and Annual Transitions
Introduction
Recovery in mental health is a complex process influenced by multiple factors – including:
1) The nature and severity of psychiatric symptoms
2) Social determinants – such as social network and work
3) One’s own experience of recovery – reflecting hope, identity and meaning
The recovery process differs across individuals and time
1. Clinical Recovery – the aim to minimize clinical symptoms and the focus in mental
health
2. Societal Recovery – i.e., regaining everyday functioning in work, social relationships,
and housing – also strongly influences the way patients restore their health
3. Personal Recovery – patients have emphasized the importance of personal recovery –
i.e., living a meaningful life
Recovery Outcomes
Assessment of Clinical Recovery
Clinical – or symptomatic – recovery was assessed with remission items, and a time criterion
of at least 6 months
The eight items assessed included:
1. Delusions 5. Passive/apathetic social withdrawal
2. Conceptual disorganization 6. Lack of spontaneity and flow of
3. Hallucinatory behavior conversation
4. Blunted affect 7. Mannerisms and posturing
, 8. Unusual thought content
Assessment of Societal Recovery
Societal recovery was assessed by observing three areas of functioning over the past 6
months – including:
1. Daily living and self-care
2. Study and housekeeping
3. Social contacts
Assessment of Personal Recovery
There is not yet a golden standard for assessing personal recovery – but there is an overall
agreement that personal recovery is ‘personal and subjective’
- Can only be assessed by the patients themselves
Results
The Four States
State 1 – Least Recovered Outcome
Patients in state 1 scored the highest impairment rate
In most measurements – patients scored mild/moderate and severe on clinical recovery
measures
- And partly dependent on societal recovery
The happiness score was low
State 2 – Partly Recovered, Negative Symptom State
In state 2 positive symptoms were mostly absent – but negative symptoms were still
frequently present
- State 2 is also characterized by problems in the societal domain
- More happiness was reported compared to state 1
State 2 seemed to have a better outcome on societal recovery compared to state 1 – but
worse than states 3 and 4
,State 3 – Partly Recovered, Positive Symptom State
In state 3, patients scored mild/moderate or severe on the positive symptoms ‘delusions’ and
‘hallucinatory behavior’
- Negative symptoms were less frequent
- Characterized by a much better outcome on societal recovery than states 1
and 2
- Independent functioning – except for the domain work
- Much higher happiness scores
State 4 – Most Recovered State
This is the best state on all recovery outcome measures – reporting good outcomes on
societal, clinical, and personal recovery
- The domain work was still a major concern
- Highest rating on happiness
Age, Gender, and Clinical Differences per State
The four states differed from each other on (1) gender, (2) duration of illness, and (3) DSM
diagnosis
- But not on age and the use of antipsychotic meds
Men were relatively more present in the least recovered and partially recovered, negative
symptoms states
Illness duration differed between the least recovered and most recovered states
1. In the least recovered state – most patients had a duration of >20 years
2. A shorter duration of illness was found in more people in the most recovered state
Discussion
The aim of the study was to identify and examine different recovery states in patients with
psychotic disorders over time – and the transition rates between states
About 40% of the patients are in the best state – meaning they are recovered on almost all
domains
, - Found a high probability of remaining in this state
In the best state (state 4) – the greatest challenge is to improve patients’ outcome on societal
recovery
- Specifically, on the aspect work, study, and housekeeping
In state 3 – high scores on positive symptoms but function well on daily living and social
contacts
- Gains could be made on work, study and housekeeping
In state 2 – care should be directed primarily on negative symptoms – especially blunted
affect and social withdrawal
- Limited number of effective interventions for negative symptoms
In state 1 – severe issues on all three domains
- No specific guidance for intervention can be formulated
Happiness – Proxy for Personal Recovery
Patients with mostly negative symptoms scored higher on happiness – compared to patients
with positive symptoms
- But experienced more societal problems
Patients with negative symptoms may be less aware of their mental health condition – and/or
are receiving more psychosocial and rehabilitation-related support
- While patients with positive symptoms – suffer from hallucinations and
delusions – leading to high burden of illness
Personal Recovery in People with a Psychotic
Disorder
, Introduction
Personal Recovery (PR) – is a subjective, multidimensional concept – described as a highly
individual process
PR in psychosis has been described as either (1) an idiosyncratic and non-linear process
containing key elements – or as (2) both process and outcome – or (3) a multi-dimensional
concept whose focus depends on individuals’ experiences
A widely endorsed theoretical basis for clinical and research purposes – is offered by the
conceptual framework of CHIME – the acronym for:
(1) Connectedness, (2) Hope, (3) Identity, (4) Meaning in life, and (5) Empowerment
Personal Recovery as an Outcome
When PR is considered an outcome – there are several validated questionnaires used to
measure PR – including:
1. The Recovery Assessment Scale (RAS)
2. The Questionnaire about the Process of Recovery (QPR)
3. The Mental Health Recovery Measure (MHRM)
There is no gold standard – and a broad and multidimensional construct of PR can lead to
ambiguous interpretations
Research Review Findings
Previous review indicated that PR improved over time when people are involved in
recovery-oriented mental health treatment
- Especially when professionals collaborate with peer providers
Another review suggested that clinical and personal recovery are only weakly associated
- Both need their own attention in treatment and outcome monitoring of people
with psychotic disorders
Results
CHIME Dimensions
Large positive associations with PR-scale total scores found for:
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