The Association between Self-Reported Self-Disturbance Phenomena and Personal Recovery in Patients with a Schizophrenia Spectrum Disorder, Siblings, and Controls

Personal recovery for patients with a schizophrenia spectrum disorder (SSD) is a process of finding meaning in life after being confronted with psychiatric symptoms. Currently, not much is known about the impact of patients' living environments and social interactions. The relationships between personal recovery and experiences of loneliness, discrimination and unsafety remain scarcely explored for patients with SSD. Understanding these relationships may contribute to developing recovery-supportive treatment strategies and improve collaboration between medical and social services. The current study aimed to examine the relationships between personal recovery and experiences of loneliness, discrimination, or neighborhood unsafety in patients with SSD receiving outpatient treatment. Hierarchical regression analyses were performed in 204 patients to assess the explained variance in personal recovery by loneliness, discrimination and neighborhood unsafety, after adjusting for a priori defined covariates. The potential interaction effects of symptom severity with the three predictors were also investigated. Loneliness explained 9.6% additional variance in personal recovery (β = -.34, p < .001). Subjective unsafety contributed modestly by explaining 2.8% (β = -.17, p = .012) of additional variance in personal recovery, while severity of unsafety did not contribute. Discrimination did not significantly explain additional variance in personal recovery. No significant interaction effects between symptom severity and the three predictors were observed in the associations. Current findings demonstrate a negative association between loneliness and personal recovery in patients with SSD, while subjective unsafety was modestly negatively associated with personal recovery. Addressing loneliness deserves special attention in mental healthcare and social services, highlighting the need for close collaboration between these domains.

We aimed to investigate whether personal recovery levels differ between those in early vs prolonged phases of psychosis and if there are different associations with objective outcomes of recovery (i.e., symptom severity and level of functioning). Participants included 131 patients with early psychosis and 83 patients with prolonged psychosis. The Recovery Assessment Scale was used to assess personal recovery in both samples. The MIRECC-GAF and the CGI-S were used as measures of objective recovery in the early psychosis group. The PANSS and QoL scales were used as measures of objective recovery in the prolonged psychosis group. People with early psychosis reported better personal recovery scores in all domains, except willingness to ask for help, compared to individuals with prolonged psychosis. Markers of objective recovery were not correlated with personal recovery in the early psychosis sample but were significantly correlated in the prolonged sample. Depressive symptoms were negatively correlated with personal recovery in the prolonged psychosis group. The relationship between personal and objective recovery may change over time and be dependent on the phase of an individual's illness. In addition, as individuals experience dysfunction over time, they may be more likely to become demoralized and experience lesser degrees of personal recovery.

ABSTRACTIntroductionPatients with schizophrenia spectrum disorders (SSD) improve in several outcome domains over the course of illness, but to different degrees. In this meta‐analysis, we investigated whether longitudinal changes in different outcome domains are associated with each other and which factors moderate these changes over time.MethodsOur protocol was preregistered in PROSPERO (CRD42024504253). We included 109 studies, identified through searches in PsycInfo, PubMed, CINAHL, and Cochrane up until November 2023, investigating longitudinal changes in at least two outcome domains (symptoms, social functioning, cognition or personal recovery) for patients with SSD with at least 1 year follow‐up. We calculated Pearson correlation coefficients for associations of changes between outcome domains. Potential moderating effects of demographic, clinical, social, or study characteristics were explored. Quality assessment was executed using the QUIPS tool.ResultsWe found substantial positive associations between changes in symptoms, social functioning, and cognition. Especially, changes in negative symptoms and overall social functioning were associated with changes in several outcome domains. Changes in personal recovery were only associated with changes in symptoms. We found more substantial improvements in combinations of outcomes for patients with a shorter illness duration, females, a lower percentage of patients diagnosed with schizophrenia, and patients receiving treatment focused on targeted outcomes.ConclusionsSymptoms, social functioning, and cognition often concurrently improve and may boost each other. This suggests that an integrated approach targeting several outcome domains jointly boosts long‐term improvement. However, changes in personal recovery seem to occur separately from other outcome domains. Therefore, targeted attention for personal recovery is needed.Trial Registration: PROSPERO: CRD42024504253

An item development, content validity, and feasibility study towards the Indonesian recovery scale for patients with schizophrenia

BackgroundSeveral studies have indicated that self-stigma is associated with depressive symptoms and could be a barrier to recovery in patients with schizophrenia-spectrum disorders. More recently, an association between autistic symptoms and self-stigma was found in schizophrenia-spectrum patients. This study aimed to investigate the association between self-stigma, autistic and depressive symptoms, and recovery in patients with schizophrenia.MethodsIn total, 105 participants were evaluated using the Autism Spectrum Quotient, the Internalized Stigma of Mental Illness Scale, the Quick Inventory of Depressive Symptomatology, and the Recovery Assessment Scale to investigate autistic symptoms, self-stigma, depressive symptoms, and recovery, respectively. The relationship between self-stigma, autistic symptoms, depressive symptoms, and recovery was assessed using structural equation modeling analysis.ResultsImpaired attention switching, one symptom of autism, was found to positively affect stereotype endorsement, which negatively influenced recovery through depressive symptoms. Moreover, problems with communication skills negatively affected recovery through depressive symptoms. Concerning self-stigma, stereotype endorsement and perceived discrimination had a negative effect on recovery through depressive symptoms, whereas stigma resistance had a direct negative effect on recovery.ConclusionsThis study may provide meaningful insight into the psychological structure of recovery and could inform effective interventions for patients with schizophrenia-spectrum disorders. This was a cross-sectionally designed study; therefore, further longitudinal studies are needed to identify the causal relationships between self-stigma, autistic and depressive symptoms, and recovery.

An exploratory study on the relationship between personal recovery and social functioning in outpatients with schizophrenia

Personal recovery refers to a person's pursuit of a full, meaningful life despite the potentially debilitating impact of a mental illness. An evidence base describing personal recovery among people at risk for developing a mental illness is lacking, limiting the potential for mental health services to support personal recovery. To address this gap, the authors synthesized the extant research describing personal recovery among people at risk for developing a mental illness. A systematic search of several literature databases (MEDLINE, Embase, APA PsycInfo, Web of Science Core Collection, and Cochrane Library) was conducted to retrieve qualitative and case studies and first-person accounts. The Joanna Briggs Institute guidelines for systematic reviews were followed. Included studies reported on participants at variable risk for developing a schizophrenia spectrum, bipolar, major depressive, or borderline personality disorder. Articles were retrieved through a librarian-assisted search and through use of additional strategies (e.g., expert consultation). Abstracts were screened by the research team, and themes were developed by using thematic synthesis. The 36 included articles were synthesized, and six themes were generated: difficulties and challenges; establishing an understanding of, and finding ways to cope with, one's mental health challenges; reestablishing a sense of agency and personhood; receiving support from people and services, as well as restoring relationships; reestablishing hope, meaning, and purpose; and overcoming stigma and destigmatizing mental illness in others. These findings provide a conceptual foundation that can guide future research on personal recovery and clinical interventions that foster it among people at risk for mental illness.

Investigating the anatomy of the helping relationship in the context of psychiatric rehabilitation: The relation between working alliance, providers’ recovery competencies and personal recovery

More than a decade ago, Whitley and Drake suggested a dimensional structure for the concept of recovery in psychotic disorder patients. This perspective of multiple objective and subjective dimensions of recovery (e.g. symptomatic, personal and functional recovery) opened a wide range of topics of practical relevance for mental health services. Future research was encouraged to address the question whether progress in one dimension of recovery is predicated by progress in another. However, a recent systematic review of personal recovery in people with a psychotic disorder observed that studies on other than clinical factors as determinants of personal recovery are scarce, as are studies of changes in dimensions of recovery over time. Thus, in spite of a long standing interest in recovery in people with severe mental illness by consumers, clinicians, and policy makers, the field is still faced with a triple fold challenge: (1) to combine different perspectives, (2) to get longitudinal information (including the course of recovery when patients are not in mental health care anymore), and (3) to develop interventions aimed at improving personal and functional recovery from psychosis. In a ten years longitudinal cohort study in the Netherlands, we aim to meet these challenges by focussing on the interrelation of dimensions of recovery and modelling the process of recovery across time.

In recent years, a new recovery model has gained ground in which recovery is understood as a process of change where individuals are able to improve their health and wellbeing, lead self-sufficient lives and strive to achieve their maximum potential (personal recovery). Despite the existence of data regarding the effectiveness of mental health day hospitals (MHDHs) in reducing relapses in terms of hospital admissions and emergencies, no studies have to date assessed how this change affected the new personal recovery model. To verify the effectiveness of MHDHs in improving personal recovery processes among people with mental disorders (MDs). A prospective cohort study. A group of patients receiving follow-up at MHDHs was compared with another group of patients receiving follow-up in other therapeutic units over a period of three months. Patient recovery at the MHDHs, assessed using the Individual Recovery Outcomes Counter (I.ROC), was found to be significantly better than that of patients attended in other units. MHDHs can contribute to the recovery of people with MDs. This is particularly important at a time when some patients may have experienced impediments to their recovery processes due to the pandemic.

In healthy individuals, active hand-movements typically elicit earlier neural processing than passive one, reflected by more positive contrast estimates of the first-order temporal derivative (TD) of hemodynamic response function (HRF) in functional MRI (fMRI) analyses. This temporal advantage might be due to prior movement-awareness and predictive mechanisms that support self-other distinction. However, it is unknown whether impaired predictive mechanisms in Schizophrenia Spectrum Disorder (SSD) influence earlier neural processing. Patients with SSD (n = 20) and healthy controls (HC; n = 20) performed active and passive hand movements, while detected delays in video feedback of their own or another person's hand. The recorded fMRI data were analysed applying TD to examine timing and second-order dispersion derivative (DD) to evaluate duration of neural responses. Compared to HC, patients with SSD exhibited delayed BOLD responses during active vs. passive movements in the right caudate nucleus, lobule VIII of right cerebellar hemisphere, left superior temporal gyrus, left postcentral gyrus, left thalamus, and left putamen/insula. Furthermore, during active movement with own hand feedback, patients with SSD showed delayed activation in the bilateral putamen and insula. Delayed insula/putamen responses' were associated with symptom severity. However, these exploratory findings remain not significant after correction for multiple comparisons and attenuated with Spearman's-rank correlations. Delayed BOLD responses in patients with SSD, particularly in the right cerebellar lobule VIII, left thalamus, and bilateral insula/putamen may contribute to disturbances in the sense of agency. Altered timing/duration of neural responses reflects new insight underlying deficits in predictive and feedback-monitoring mechanisms in SSD.

Background: One goal within positive psychiatry is to support the personal recovery of persons with mental illness and providing opportunities for well-being.Aim: The current article aims to introduce readers to the concept of personal recovery and the potential and importance of recovery-oriented services and measures.Methods: A literature review was conducted to help consider the domains of ‘personal recovery’, ‘recovery-oriented services/interventions’, and ‘measures’. A database search was complemented with a web-based search. Both medical subject heading (MESH) terms and free-text search terms were used.Results: Literature from research journals, grey literature, and websites were included. Within this context, recovery does not refer to a cure but involves a process in which a person acts as an agent to develop new goals and meaning in life, despite and beyond limitations posed by the illness and its consequences. A positive focus on recovery is in sharp contrast to historical deterministic and pessimistic concepts of mental illnesses. Recovery-oriented services such as peer support, assertive community treatment, supported employment/education/housing, illness self-management, and decreasing self-stigma are highlighted. A review of 27 measures that focus on personal recovery and promotion of well-being are also discussed.Conclusions: The literature overview presents perspectives and knowledge of how to develop positive psychiatry, how mental health services and their partner organizations may become more recovery oriented and help persons reach well-being and a better quality of life. This study is limited to a narrative review and may precede future systematic reviews.

Autism Spectrum Disorder (ASD), characterized by socio-communicative abnormalities and restricted, repetitive, and stereotyped behaviors, is part of Neurodevelopmental Disorders (NDDs), a diagnostic category distinctly in accordance with the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, (DSM-5), clearly separated from Schizophrenia Spectrum Disorder (SSD) (schizophrenia, schizophreniform disorder, schizoaffective disorder, schizotypal personality disorder). Over the last four decades, this clear distinction is gradually being replaced, describing ASD and SSD as two heterogeneous conditions but with neurodevelopmental origins and overlaps. Referring to the proposal of a neurodevelopmental continuum model, the current research's aim is to provide an update of the knowledge to date on the course of clinical symptoms and their overlaps among ASD and SSD. A narrative review of the literature published between January 2010 and June 2023 was conducted. Five studies were included. All studies show a global impairment in both conditions. Two studies show a focus on neurodevelopmental perspective in ASD and SSD. Only one study of these adopts a longitudinal prospective in terms of prognostic markers among ASD and SSD. Three studies underline the overlap between ASD and SSD in terms of negative, disorganized and positive symptomatology. To date, there is a gap in the current scientific literature focused on ASD-SSD course of clinical symptoms and their overlaps from a neurodevelopmental perspective. Future longitudinal studies to identify risk markers and tailored treatments are needed.

Is clinical insight a determinant factor of subjective recovery in persons living with schizophrenia or schizoaffective disorders?

The Relationship Between Trauma and Clinical Outcome Variables Among Older Adults With Schizophrenia Spectrum Disorders