Subjective experience of diagnosis and treatment in two adolescents with first-episode schizophrenia

Abstract

The results of a qualitative study on the subjective experience of two adolescents in treatment for first-episode schizophrenia (FESZ) are presented here. We reconstructed the relevant aspects of the diagnosis and treatment processes based on the elaboration of said experience carried out by the participants. We therefore incorporated the perspective of the patients, family members and psychotherapists. The recovery from FESZ, understood as a positive adaptation to the experience of psychosis, is closely connected with the possibility of the adolescent to re-embark on his/her biographical trajectory. In this sense, the concept of recovery from FESZ increasingly emphasizes the subjective dimension of this process. The aim of the study is to understand the subjective experience of diagnosis and treatment processes from the perspective of two patients with FESZ who received comprehensive treatment in the Chilean public health system, their family members and their psychotherapists. The study performed semi-structured interviews and a qualitative content analysis in order to understand and describe, from their perspectives, the subjective experiences associated with the processes of diagnosis and treatment of FESZ. The inclusion of patients, relatives and psychotherapists allowed complementing the perspectives on the phenomenon under study. The results suggest that the central phenomena of appropriation of FESZ and resistance to the appropriation of FESZ are relevant in the accounts of these two cases. The family's emotional climate associated with the experience of FESZ converge in these phenomena, as well as the participation of the adolescent in the processes of diagnosis and treatment, specifically as these processes favor or hinder an appropriation of the psychopathological experience and this enables the reestablishment of the autobiographical continuity. Appropriation of FESZ seems to rely on future prospects that preserve some possibility of performing prior potentialities and expectations, or at least to adapt them in a tolerable way for the adolescents and their environment. Such findings highlight the relevance of developing interventions that encourage more hopeful future perspectives for individuals facing a first psychotic episode and their families

The lived experience of mental disorders in adolescents: a bottom‐up review co‐designed, co‐conducted and co‐written by experts by experience and academics

“…Parents typically experience dramatic changes in their relationship with their unwell kids: “ Where is my daughter gone, because that's not her ” 105 . The onset of a mental disorder forces the parents to redefine their image of their kids 106 , “ mourning the child who would have developed normally ” 107 .…”

“…Parents may experience great suffering because of the environmental stigma directed towards their kids: “ That hurt me… when other parents were saying to their child 'don't play with him ” 122 . Parents may feel “ distressed ” by the mental suffering of their kids 108 , and at the same time feel helpless 105,106,108 as they do not have “ the right weapons” to face the mental disorder 123 . Taking care of a kid with a mental disorder is experienced as “mentally… and physically exhausting ” 105 .…”

“…In this context, the role of health care professionals in adequately and sensitively communicating the diagnosis is of vital importance, as it may otherwise elicit confusion and misunderstanding. For example, many young individuals report a lack of clear information and explanation about the implications of their diagnosis: “ They told me I had schizophrenia… but I didn’t know what schizophrenia was; I didn’t know that disease” 106 .…”

“…Parents often experience their kid's diagnosis of mental disorder as “ a shock ” 106 , “ an earthquake ” 106 , or “ like being punched in the stomach ” 129 . The signs of their kids’ difficulties may be “ little strange things ” hard to notice 56 .…”

Introduction to the Special issue on Qualitative and Quantitative Research in Child and Adolescent Psychotherapy

“…The recovery from for first-episode schizophrenia (FESZ), understood as a positive adaptation to the experience of psychosis, is closely connected with the possibility of the adolescent to re-embark on his/her biographical trajectory. Abarzua, Venegas, and Hidalgo (2016) put attention to the subjective experience of diagnosis and treatment in two adolescents with FESZ. The study performed semistructured interviews and qualitative content analysis in order to describe, from patients' perspectives, the subjective experiences associated with the processes of diagnosis and treatment of FESZ.…”