3 results
““Why shouldn’t I expect things from life?” – what people with lived experience from psychosis highlight as important to their personally defined long-term recovery process”
- G. Åsbø, H. Haavind, S. Hembre Kruse, K. Fjelnseth Wold, W. Ten Velden Hegelstad, K. Lie Romm, T. Ueland, I. Melle, C. Simonsen
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S117
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Introduction
Many people with lived experience from psychosis recover and thrive, contrary to the common stigmatizing belief that they will be chronic “patients”. But there are several ways to understand recovery, one is as a subjective process best explored through qualitative interviews with people who have recovered from psychosis. However, there is a need for more qualitative interview studies exploring what has been important for long-term subjective recovery for people with lived experience from psychosis outside of treatment. Exploring themes that are novel than previous research will have important clinical implications.
ObjectivesThis study aims to qualitatively explore what people with lived experience from psychosis believe has been the most important to attain and sustain their long-term personally defined recovery.
MethodsQualitative interviews with 20 individuals participating in two follow-up-studies (TOP and TIPS-study) 10 and years 20 years after first treatment for a psychotic disorder (schizophrenia- or bipolar spectrum), respectively. All participants were in either clinical recovery (symptom remission and adequate functioning) or personal recovery (self-rated questionnaire) or both. Interviews were analyzed with thematic analysis in group meetings between the PhD-candidate, the main supervisor, a professor emerita in qualitative method and a co-researcher with lived experience from bipolar disorder.
ResultsParticipants defined recovery differently, but: “understanding myself”, “stable symptoms” and “finding the life that is right for you” were of the most common definitions. Tentatively, five main themes appear to be the most salient contributions to recovery: 1. Balance stress management with taking risks and following personal goals. 2. Accepting experience/”owning your story” in order to strategically disclose and manage stigma. 3. Taking agency over own recovery and mastery of everyday life. 4. Social support is crucial, but should change over time depending on need. 5. Feeling a sense of belonging to society does not need to entail “normality”.
ConclusionsRecovery was defined differently by each participant, but common themes across participants highlight that appropriate risk-taking, accepting your experience/owning your story, sense of agency, social support and inclusion are important to long-term recovery in psychosis.
Disclosure of InterestNone Declared
Identifying early signs of Treatment Resistance in First Episode Psychosis to revise and aid further treatment
- K. F. Wold, C. B. Flaaten, G. Åsbø, L. Widing, I. Melle
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S444-S445
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Introduction
Approximately 1/3 of patients with first episode psychosis (FEP) will not benefit from antipsychotic medications and are considered treatment resistant (TR). TR is currently defined as sustained lack of remission with functional loss in the context of two adequate trials of different antipsychotics. Studies suggest that early initiation of clozapine treatment support a better course of illness in TR. Most treatment guidelines recommend clozapine after two antipsychotic failures. In practice, increased dosages of other antipsychotics or polypharmacy are tried out first. Identifying early signs of TR and revising treatment is thus important. Since the TR definition requires adequate lengths of treatment attempts, they are difficult to apply in FEP.
ObjectivesThe aim of the current study is to 1) investigate if a shorter observation period can be used to identify subgroups of FEP patients with early signs of TR (no indication of early clinical recovery - NoECR) and 2) investigate differences in antipsychotic treatments over the first year compared to patients in full or partial early recovery (ECR/ partial ECR).
MethodsParticipants 18 to 65 years in their first year of treatment were recruited from major hospitals in Oslo. The participants met the DSM-IV criteria for schizophrenia, schizophreniform disorder, schizoaffective disorder, and psychotic disorder NOS. A total of 387 completed baseline clinical assessments and 207 one-year follow-up. The SCID-I for DSM-IV was used for diagnosis, symptoms were measured with the SCI-PANSS. Treatment history was gathered through interviews and medical charts. No-ECR was defined as a) Not meeting remission criteria for at least 12 weeks at follow-up, and b) Not regained functioning, i.e., a GFS score < 60. ECR was defined as a) Meeting the criteria for remission and b) Regained functioning, i.e., a GFS score >=61. Partial ECR did not meet these criteria.
ResultsAt one year follow-up, 47% met the criteria for no-ECR, 29% the criteria for ECR and 24% the criteria for partial ECR. Baseline predictors of the no-ECR group corresponded to previously identified predictors of long-term TR. Only 35 (17%) participants met the full criteria for TR at this point. Of the 97 in the no-ECR group, 18 (19%) were in an ongoing trial (p<0.001 vs ECR/partial ECR) and 21 (22%) were using the same medication over the whole follow-up year (p =.008 vs ECR /partial ECR) despite lack of significant clinical effect.
ConclusionsWe show that the mostly used consensus definition of TR identifies only a proportion of FEP patients without sufficient clinical and functional improvement at one year follow-up. The main reason for not meeting the criteria is a lack of two adequate antipsychotic trials at this point of time. However, only half of these were in an ongoing trial despite recommendations in clinical guidelines.
Disclosure of InterestNone Declared
The relationship between visual hallucinations, functioning and suicidality over the course of illness: a 10-year follow-up study in first-episode psychosis
- I. Kreis, K. Fjelnseth Wold, G. Åsbø, C. Simonsen, I. Melle
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S441
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Introduction
Visual hallucinations are a common symptom across psychotic disorders and have been linked to illness severity, impaired functioning, and increased suicide risk. However, little is known about the stability of this relationship over the long-term course of illness.
ObjectivesThis study aims to assess whether the presence of visual hallucinations is associated with illness severity, functioning and suicidality, early and late in the course of illness. It further explores the potential role of childhood trauma in this context, which has been linked to both visual hallucinations and suicidality.
MethodsA sample of 185 individuals with first-episode psychosis was assessed with structured clinical interviews and self-report questionnaires at time of study inclusion and at 10-year follow-up. Those with lifetime experience of visual hallucinations at inclusion (VH+/+) as well as those where visual hallucinations first developed during the follow-up period (VH-/+) were compared to a group without such experiences (VH-/-). To this end, multinomial logistic regression models were applied, with a range of clinical and demographic variables as predictors.
ResultsAt time of inclusion, the VH+/+ group had significantly higher symptom severity scores, lower functioning scores, and were more likely to have a history of multiple suicide attempts. There were no such differences between the VH-/+ and the VH-/- group. At follow-up, this pattern of findings partially reversed. Here, only the VH-/+ group differed from the VH-/- group in terms of higher symptom severity scores and lower functioning scores. However, the VH+/+ group was still more likely to report multiple suicide attempts during the follow-up period, whereas VH-/+ did not differ from VH-/-. Notably, childhood trauma scores did not differ between groups.
ConclusionsIn line with previous studies, these findings point to an association between visual hallucinations and illness severity, functioning and suicidality. However, this association seems to change over the course of illness. Together, this highlights the relevance of assessing visual hallucinations in the clinical setting and monitoring their development over time.
Disclosure of InterestNone Declared