scholarly journals A qualitative study exploring personal recovery meaning and the potential influence of clinical recovery status on this meaning 20 years after a first-episode psychosis

2021 ◽  
Author(s):  
Donal O’Keeffe ◽  
Ann Sheridan ◽  
Aine Kelly ◽  
Roisin Doyle ◽  
Kevin Madigan ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
First Episode Psychosis ◽  
First Episode ◽  
Service Users ◽  
Personal Recovery ◽  
Potential Influence ◽  
Psychotic Illness ◽  
Clinical Recovery ◽  
Episode Psychosis

Abstract Purpose Long-term data on recovery conceptualisation in psychotic illness are needed to support mental health services to organise themselves according to recovery-oriented frameworks. To our knowledge, no previous research has investigated how first-episode psychosis (FEP) service users (sampled across psychotic illness type) perceive recovery beyond 5 years after diagnosis. We aimed to explore personal recovery meaning with individuals 20 years after their FEP and examine the potential influence of clinical recovery status on how they defined recovery (i.e. personal recovery). Methods Twenty participants were purposefully sampled from an epidemiologically representative FEP incidence cohort. At 20-year follow-up, semi-structured interviews were conducted with 10 cohort members who met full ‘functional recovery criteria’ (Clinically Recovered Group) and 10 who did not (Not Clinically Recovered Group). A thematic analysis was performed to develop shared themes and group-specific sub-themes to capture agreement and divergence between groups. Results Five shared themes were produced: pursuing balance in conflict, generating meaning in life, experiencing a dynamic personal relationship with time, redressing inequality while managing added challenges/vulnerability, and directing life from resilience to flourishing. The five group-specific sub-themes developed illuminate differences in the meaning ascribed to personal recovery by each group. Conclusion Findings emphasise the role of time in how personal recovery is conceptualised by service users and identify ways clinical recovery may influence personal recovery meaning in FEP at mid-later life. Mental health services failing to consider temporal changes in meaning-making and discounting clinical recovery risk ignoring key factors affecting personal recovery.

scholarly journals The iHOPE-20 study: Relationships between and prospective predictors of remission, clinical recovery, personal recovery and resilience 20 years on from a first episode psychosis

2019 ◽  
Vol 53 (11) ◽  
pp. 1080-1092 ◽  
Author(s):  
Donal O’Keeffe ◽  
Ailish Hannigan ◽  
Roisin Doyle ◽  
Anthony Kinsella ◽  
Ann Sheridan ◽  
...  
Keyword(s):  
Mental Health ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Full Time ◽  
Personal Recovery ◽  
Clinical Recovery ◽  
Episode Psychosis

Objective: Knowledge of outcome in psychotic illness is limited by the paucity of very long-term epidemiologically representative studies of incidence first episode psychosis (FEP) cohorts that measure and compare outcomes reflecting modern clinical practice, mental health policy and research agendas. Our study aimed to address this gap. Method: iHOPE-20 is a prospective 20-year follow-up study of a FEP incidence cohort ( N = 171) conducted between 2014 and 2017 in Ireland. Data from previous studies and medical records were used to recruit cohort members. We assessed remission, clinical recovery, personal recovery and resilience at 20 years; explored the relationships between these outcomes and examined the predictive value of baseline characteristics in determining them. Results: At follow-up, 20 out of 171 cohort members (11.70%) were deceased. We assessed 80 out of 151 alive cohort members (53% recruitment rate); 65% were in remission; 35.2% were in Full Functional Recovery and 53.7% confirmed they were fully recovered according to their personal definition of recovery. A complex array of relationships between outcomes was found. Outcomes were better for people who had a short duration of untreated psychosis, displayed higher premorbid social adjustment (between the ages of 5–11) and at baseline, were older, not living alone, in full-time employment, given a non-affective diagnosis, and had lower Global Assessment of Functioning scores. Conclusion: Among participants, full remission of psychotic symptoms and personally defined recovery was not just possible but likely in the very long term. However, attaining positive functional outcomes and building resilience in FEP remain key challenges for mental health services.

scholarly journals Retrospective Experiences of First-Episode Psychosis Treatment Under Open Dialogue-Based Services: A Qualitative Study

2021 ◽  
Author(s):  
Tomi Bergström ◽  
Jaakko Seikkula ◽  
Juha Holma ◽  
Päivi Köngäs-Saviaro ◽  
Jyri J. Taskila ◽  
...  
Keyword(s):  
Mental Health ◽  
Family Involvement ◽  
Thematic Analysis ◽  
Integrated Approach ◽  
First Episode Psychosis ◽  
First Episode ◽  
Service Users ◽  
Episode Psychosis ◽  
Catchment Areas ◽  
Open Dialogue

AbstractOpen Dialogue (OD) is an integrated approach to mental health care, which has demonstrated promising outcomes in the treatment of first-episode psychosis (FEP) in Finnish Western Lapland region. However, little is known how treatment under OD is retrospectively experienced by the service users themselves. To address this, twenty participants from the original Western Lapland research cohort diagnosed with psychosis (F20–F29) were asked about their treatment of FEP, initiated under OD 10–23 years previously. Thematic analysis was used to explore how the treatment was experienced. Most participants viewed network treatment meetings as an important part of their treatment, as they enabled interactions with other people and the chance to go through difficult experiences. A minority of the participants had mixed experiences regarding family involvement and immediate home visits. OD may have the potential to promote therapeutic relationships, but replications from other catchment areas are needed.

scholarly journals COVID and early intervention: the impact of COVID-19 on referrals to an early intervention service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S112-S112
Author(s):  
Adam Whyte ◽  
Alastair Reid
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Mental Health Services ◽  
Health Services ◽  
First Episode Psychosis ◽  
First Episode ◽  
Intervention Service ◽  
Number Of Patients ◽  
Episode Psychosis ◽  
The Impact

AimsCOVID-19 has a demonstratable impact on the population's mental health and is associated with an increased incidence of psychiatric disorders, including patients experiencing psychotic presentations. The aim of this study was to explore whether referral rates within a county-wide Early Intervention (EI) service changed in response to the COVID-19 pandemic. The EI service provides NICE approved treatments and support for patients experiencing a First Episode Psychosis (FEP).MethodData were collected from all referrals to the EI service between March–December 2019 and March–December 2020. Clinical notes were reviewed to ascertain whether the referred patient was assessed and if they were subsequently accepted on to the team's caseload.ResultDuring the March–December 2019 period 147 referrals were made to the EI service, with 66 patients being accepted for treatment by the service (44.9% of referrals). In March–December 2020, 127 referrals were made, a 13.6% reduction compared to the same period in 2019, however 70 referrals were accepted (55.1% of referrals).Whilst the overall referrals declined during the COVID-19 period, there were notable increases in both April and August 2020, by 25.0% and 70.0% respectively.ConclusionAlthough overall referrals to the EI service reduced during the COVID-19 pandemic compared similarly to the previous year, there was a noteworthy increase in the proportion of patients accepted onto the team's caseload.Potential explanations for this finding include the possibility of an increased incidence of first episode psychosis during this period, or that restrictions in accessing primary care and secondary mental health services during the COVID-19 pandemic reduced the number of patients being referred whose symptoms were not representative of First Episode Psychosis (FEP).This study highlights that mental health services, such as EI teams, have experienced a persistent level of need over the past year and that ongoing investment in psychiatric services is warranted to meet this sustained requirement for support and interventions.

scholarly journals The Lambeth Early Onset Crisis Assessment Team Study: general practitioner education and access to an early detection team in first-episode psychosis

2007 ◽  
Vol 191 (S51) ◽  
pp. s133-s139 ◽  
Author(s):  
Paddy Power ◽  
Eduardo Iacoponi ◽  
Nicola Reynolds ◽  
Helen Fisher ◽  
Morris Russell ◽  
...  
Keyword(s):  
Mental Health ◽  
General Practitioner ◽  
Mental Health Services ◽  
Early Detection ◽  
Health Services ◽  
Early Onset ◽  
First Episode Psychosis ◽  
First Episode ◽  
Referral Rates ◽  
Episode Psychosis

BackgroundThere are few evaluations of strategies to improve rates of early detection and treatment of patients with first-episode psychosisAimsTo evaluate the effectiveness of a general practitioner (GP) education programme and an early detection assessment team (the Lambeth Early Onset Crisis Assessment Team; LEO CAT) in reducing delays in accessing treatment for first-episode psychosis patients.Method46 clusters of GP practices randomised to GP education in early detection with direct access to LEO CATv. care as usual. Primary outcome measures were GP referral rates, duration of untreated psychosis (DUP) and delays in receiving treatment. Results 150 patients with first-episode psychosis were recruited; 113 were registered with the study GPs, who referred 54 (47.7%) directly to mental health services. Significantly more intervention group GPs (86.1% v. 65.7%) referred their patients directly to mental health services and fewer patients experienced long delays in receiving treatment. However, their overall DUP was unaffectedConclusionsEducating GPs improves detection and referral rates of first-episode psychosis patients. An early detection team reduces the long delays in initial assessment and treatment. However, these only impact on the later phases of the DUP. Broader measures, such as public health education, are needed to reduce the earlier delays in DUP.

Pathways to Care and Patterns of Care in First Episode Psychosis Patients Treated in Community Based-mental Health Services. A 5-Years Follow-up from the PICOS

2017 ◽  
Vol 41 (S1) ◽  
pp. S160-S160
Author(s):  
E. Miglietta ◽  
A. Lasalvia ◽  
C. Comacchio ◽  
D. Cristofalo ◽  
C. Bonetto ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Mental Health Services ◽  
Health Services ◽  
First Episode Psychosis ◽  
First Episode ◽  
Community Based ◽  
Episode Psychosis ◽  
Pathway To Care

IntroductionInternational treatment guidelines recommend that key elements to reduce the burden of psychosis are the early identification of people and the adoption of specific evidence based interventions.ObjectivesTo investigate the pathway to care and patterns of interventions provided by community based-mental health services (CMHS) to a cohort of first-episode psychosis (FEP) patients over 5-years period, exploring in which degree guidelines are met in routine clinical practice.MethodsStudy conducted in the context of the Psychosis Incident Cohort Outcome Study (PICOS), a multisite naturalistic research conducted in the Veneto Region (Italy) on FEP patients in a 4.6 million inhabitants catchment area. A comprehensive set of standardized measures was used, including ad hoc schedules to collect information on referrals to psychiatric services and on pharmacological and psycho-social treatments according to a multiwave follow-up design (1-, 2- and 5 years).ResultsThree hundred and ninety-seven FEP patients were assessed at BL, 286 at 1 year, 233 at 2 years and 205 at 5 years. 47.4% of patients were helped to seek care by a relative and more than one half entered the treatment route through an emergency access. Regarding the interventions received, 96% of patients had been prescribed neuroleptics and atypical were the most prescribed class (66.9%). Only half received a psychosocial intervention during the first year and this percentage progressively decreased at each FU.DiscussionFindings highlight discrepancies between interventions provided by CMHS and the best treatment options recommended by guidelines, suggesting the need to implement specific initiatives aiming to close the gap between research and clinical practice.

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