Investigating personal and clinical recovery processes in people with first episode psychosis

Austin, Stephen F.; Hjorthøj, Carsten; Baagland, Helle; Simonsen, Erik; Dam, Jesper

doi:10.1111/eip.13258

Cited by 9 publications

(14 citation statements)

References 61 publications

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“…In sum, 68% experienced at least one positive outcome, while 25.8% had all three positive outcomes. The rate of personal recovery of 50.8% in the present 10-year follow-up study is relatively consistent with the four previous FEP studies reporting 46.9% at 1-year follow-up, 35% at 2-year follow-up, 53.7% and 51.9% at 20-year follow-up (Austin et al, 2022;Dubreucq et al, 2022;O'Keefe et al, 2019;Peralta et al, 2022), of which two also used the QPR-15. Thus, the proportion of FEP participants experiencing personal recovery seems to be fairly consistent across the first 20 years after start of treatment.…”

Section: Discussionsupporting

confidence: 91%

“…The few FEP studies that have investigated the rate of personal recovery report 46.9% at 1-year follow-up (Dubreucq et al, 2022), 35% at 2-year follow-up (Austin, Hjorthoj, Baagland, Simonsen, &Dam, 2022), and53.7% and51.9% at 20-year follow-up (O'Keefe et al, 2019;Peralta et al, 2022). Lower rates were found for people with psychosis that were in need of treatment, with 14.5% in a cognitive-behavioral therapy study (Best et al, 2020) and 17.4% in an integrative family intervention study (Yu et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

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A good life with psychosis: rate of positive outcomes in first-episode psychosis at 10-year follow-up

Simonsen,

Åsbø,

Slade

et al. 2024

Psychol. Med.

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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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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

A good life with psychosis: rate of positive outcomes in first-episode psychosis at 10-year follow-up

Simonsen,

Åsbø,

Slade

et al. 2024

Psychol. Med.

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“…Clinical recovery (CR) is defined as stable symptom remission in the context of regained function over a sustained period of at least 6 months by some- and up to 24 months by other criteria [ 11 , 12 , 13 ]. Recovery rates in FEP vary between 10 and 35%, depending on the definition of recovery and the length of the follow-up period [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Early identification of treatment non-response in first-episode psychosis

Wold¹,

Berg²,

Flaathen³

et al. 2023

Eur. Psychiatr.

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Background Approximately one-third of patients with psychotic disorders does not respond to standard antipsychotic treatments. Consensus criteria for treatment resistance (TR) may aid the identification of non-response and subsequent tailoring of treatments. Since consensus criteria require stability of clinical status, they are challenging to apply in first-episode psychosis (FEP). This study aims to investigate (a) if an adaptation of consensus criteria can be used to identify FEP patients with early signs of TR (no early clinical recovery—no-ECR) after 1 year in treatment and (b) to what extent differences in antipsychotic treatments differentiate between outcome groups. Methods Participants with FEP DSM-IV schizophrenia spectrum disorders were recruited during their first treatment. A total of 207 participated in the 1-year follow-up. Remission and recovery definitions were based on adaptations of the “Remission in Schizophrenia Working Group” criteria and TR on adaptations of the “Treatment Response and Resistance in Psychosis” (TRRIP) working group criteria. Results 97 participants (47%) could be classified as no-ECR, 61 (30%) as ECR, and 49 (23%) as with partial ECR (P-ECR). Statistically significant baseline predictors of no-ECR matched previously identified predictors of long-term TR. Only 35 no-ECR participants had two adequate treatment trials and met the full TRRIP criteria. 21 no-ECR participants were using the same medication over the follow-up year despite the lack of significant effects. Conclusion The difference in the percentage of FEP participants classified as no-ECR versus TR indicates that we may underestimate the prevalence of early TR when using consensus criteria.

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“…However, recovery can be viewed as a process, or individual journey, or as a clinical outcome. Clinical recovery is synonymous with cure or symptom alleviation (Austin et al, 2022) while personal recovery is person‐centred and independent of clinical outcomes (Waldemar et al, 2016). The distinction is important as personal recovery highlights hope, connectedness, identity, empowerment, meaning as well as resilience (Jacob, 2015; Leamy et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

The experience of healthcare professionals implementing recovery‐oriented practice in mental health inpatient units: A qualitative evidence synthesis

Chatwiriyaphong,

Moxham,

Bosworth

et al. 2023

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject? The principles of personal recovery are primarily applied in outpatient and community settings as these settings provide continuity of care and recovery‐based community programs supporting consumers' recovery journey. A range of healthcare professionals are involved in the care of people within mental health in‐patient units, including nurses, psychiatrists, psychologists, occupational therapists and social workers. The integration of recovery‐oriented care in mental health inpatient units may be impaired by a lack of confidence among mental health professionals. What this paper adds to existing knowledge? Developing hope and a safe place is an integral part of recovery‐oriented practice within mental health inpatient units. Instilling connectedness is a relevant recovery principle; however, there may be greater barriers in mental health settings which traditionally prioritise safety and risk mitigation practices to prevent perceived harmful behaviours. Staff workload and inadequate understanding of recovery concepts present challenges to promoting recovery‐oriented care in everyday practice. Using strength‐based practice is critical in promoting a safe space for consumers by providing psychosocial interventions and person‐centred care. What are the implications for practice? The provision of recovery‐oriented practice requires adopting a collaborative approach that places a strong emphasis on the involvement of consumers and their families. Empowering mental health professionals to believe that recovery‐oriented practice is possible in mental health inpatient units is crucial. Mental health professionals need to create a safe environment and positive relationships through respect and empathy for consumers and their family members. AbstractIntroductionRecovery‐oriented practice underpins an individual's personal recovery. Mental health nurses are required to adopt a recovery‐oriented approach. Globally, a paucity of literature exists on mental health professionals' experience of recovery‐oriented practice in mental health inpatient units.AimThe aim of this synthesis was to explore the experiences of healthcare professionals regarding recovery‐oriented care in mental health inpatient units by appraising and synthesising existing qualitative research.MethodThree databases, including MEDLINE, PsycINFO and CINAHL were searched between 2000 and 2021. Data were extracted and synthesised using thematic integrative analysis. The quality of included studies was assessed with the CASP Critical Appraisal Checklist.ResultsTen qualitative research projects met the inclusion criteria. Four themes were identified (i) developing a safe and hopeful space, (ii) promoting a healing space, (iii) instilling connectedness and (iv) challenges to realising recovery‐oriented care.DiscussionMental healthcare professionals perceived the principles of recovery‐oriented care to be positive and include: therapeutic space, holistic care and person‐centred care. Nevertheless, findings revealed limited knowledge and uncertainty of the recovery concept to be key barriers that may hinder implementation into practice.Implications for PracticeRecovery‐oriented practice must underpin consumer and family engagement, treatment choices and continuity of care to facilitate consumer's personal recovery.

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Investigating personal and clinical recovery processes in people with first episode psychosis

Cited by 9 publications

References 61 publications

A good life with psychosis: rate of positive outcomes in first-episode psychosis at 10-year follow-up

A good life with psychosis: rate of positive outcomes in first-episode psychosis at 10-year follow-up

Early identification of treatment non-response in first-episode psychosis

The experience of healthcare professionals implementing recovery‐oriented practice in mental health inpatient units: A qualitative evidence synthesis

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