Recovery from Psychosis:What Factors are Important?

Fleur-Michelle Coiffait

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Overview

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Overview• Recovery Factors

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Overview• Recovery Factors• Implications for Further Research

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Overview• Recovery Factors• Implications for Further Research• Limitations of this Review

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Overview• Recovery Factors• Implications for Further Research• Limitations of this Review• References

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Factors associated with recovery,

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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 services

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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)

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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

factor

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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 connections

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Supportive Therapy• Quality of therapeutic alliance key

determinant of outcome (Tatton & Tarrier, 2000)

• Engaging service-user important for effective communication

• Collaborative approach

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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)

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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)

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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 interventions

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Other Internal Factors

• Hope, belief in recovery• Enjoyment of life• Self-esteem• Sprituality (Stewart, 2003; Dorrer, 2006)

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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 Factors

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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 psychosis

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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 field

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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.

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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.

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