Challenges to recovery following early psychosis: Nursing implications of recovery rate and timing

Early intervention in first episode psychosis is based on an indicated prevention approach that has early illness identification and timely recovery as primary goals. Nurses are instrumental in helping individuals and families achieve both aims. To better understand recovery following a first episode, a prospective cohort of 260 individuals participating in a three-year early intervention program was monitored for achievement of recovery outcomes. Two outcome measures were used to examine the recovery rate and timing of the cohort: (1) partial recovery was comprised of two criteria: (a) symptom control (psychosis and mania), and (b) daily functioning, and 2) comprehensive recovery was measured by three criteria: (a) symptom control; (b) daily functioning; and, (c) quality of life. Survival analysis, including the Kaplan-Meier statistic, and Cox hazard regression were used to examine the cohort's rate and timing for both measures. One hundred and seventy-four individuals attained partial recovery with half (51.1%) reaching the target within nine months. Comprehensive recovery was achieved by 59 individuals (22.7%), primarily in year two and three of treatment. Issues impacting quality of life delayed recovery for the majority of program participants. The gap between psychosis remission and satisfaction/fulfillment with one's everyday life is troubling, but could be improved with stronger nursing support and influence. Sharing the recovery experience with individuals and families that supports their life goals and the discovery of meaning, hope and purpose in the face of illness is the work of nurses. Suggestions for strengthening nursing's impact are considered.     

A Population Based Analysis of Subclinical Psychosis and Help-Seeking Behavior

Clinically defined psychosis is recognizable and distinguishable from nonclinical or subclinical psychosis by virtue of its clinical relevance (ie, its associated distress and its need for care and/or treatment). According to the continuum hypothesis, subclinical psychosis is merely quantitatively different from more extreme phenotypic expressions and as such should also be indicative of distress and help-seeking behavior but to a lesser extent. Using data from the Adult Psychiatric Morbidity Survey, the current study focused on self-reported psychosis and help-seeking experiences in a general population sample free from clinically defined psychosis (N = 7266). After statistically controlling for the effects of a series of potential help-seeking correlates the findings showed that subclinical psychosis symptom experience was significantly associated with various forms of help-seeking behavior. Individuals who reported subclinical experiences of thought control, paranoia, and strange experiences were on average 2 times more likely to attend their general practitioner for emotional problems compared with those individuals who reported no psychosis. Individuals who reported subclinical experiences of paranoia were 3 times more likely to be in receipt of counseling/therapy compared with those with no experience of paranoia. Multiple subclinical psychotic experiences also predicted elevated help-seeking behavior. These findings may have a positive impact on the detection of individuals who are at increased risk of psychological distress and aid in the design and implementation of more effective treatments at both clinical and subclinical levels.     

Bokrecensioner

Samtliga patienter som hade vårdats på psykiatriska kliniken vid S:t Görans sjukhus under första halvåret 1980 tillsändes i juli 1980 ett frägeformulär om deras erfarenheter av vården. Svar erhölls av 44 procent. Tvä tredjedelar av de svarande hade få eller inga anmärk-ningar. Femton procent, varav flertalet yngre personer, var kritiska inför det mesta. Den viktigaste slutsatsen av undersökningen är att informationen om psykiatrisk behandling och om psykiatrins arbetssätt måste fördju-pas och att återkommande patientkäter är motiverade.     

Emotional reactivity to war stressors: An experience sampling study in people with and without different psychiatric diagnoses

There is a lack of knowledge regarding real-time emotional reactivity to high-intensity stressors, particularly in people with mental illness, a potentially vulnerable population. The current study aimed to examine negative emotional reactions to recurring high-intensity stressors within a continuous war situation, in people with different psychiatric diagnosis types. Experience sampling method was used to examine emotional reactions among 143 civilians exposed to rockets during the 2014 Israel–Gaza war, of them 18.2% with psychosis, 14.7% with anxiety or depression and 67.1% without mental illness. Participants reported exposure to rocket warning sirens and the levels of 10 negative emotions twice a day for 30 days. Negative emotional levels were higher on most emotions following high-intensity stressors (sirens), that is, emotional reactivity was demonstrated in real-time during war. Overall, no difference in reactivity was found among the three study groups. Moreover, people with anxiety/depression were less reactive than people without mental illness on sadness and being overwhelmed. The findings indicate similar and sometimes lower emotional reactivity to high-intensity stressors in people with mental illness compared to the general population. Nevertheless, people with mental illness seem to have significant emotional needs during war, to be addressed in prevention and intervention efforts.     

Reappraisal of Dementia Praecox: Focus on Clinical Psychopathology

Summary: One century of investigation in schizophrenia is still not enough to elucidate all the complex issues related to the essential symptomatology, clinical boundaries, aetiology, pathogenesis, outcome, treatment and prevention. Despite the extraordinary progress in the neuroscience field, no definitive data is available for schizophrenia. On the other hand, after the successful activity of the psychopharmacological era, the clinical psychopathological investigations were reduced and almost replaced by the mechanistic operational diagnosis. This has caused an impoverishment in psychiatry. Tracing some historical aspects of schizophrenia since the kraepelinian Dementia Praecox, this article intends to demonstrate the failure of the current model of diagnosis and current limitation of neuroscience. It advocates the reinforcement of Clinical Psychopathology as the foundation for correct and appropriate first steps in the investigation of schizophrenia. The splitting disease is still a challenge to biological psychiatry.