Article

A scientific agenda for the concept of recovery as it applies to Schizophrenia

University Behavioral HealthCare and Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, United States.
Clinical psychology review (Impact Factor: 7.18). 04/2008; 28(7):1108-24. DOI: 10.1016/j.cpr.2008.03.004
Source: PubMed

ABSTRACT Recovery is now a widely discussed concept in the field of research, treatment, and public policy regarding schizophrenia. As it has increasingly become a focus in mainstream psychiatry, however, it has also become clear both that the concept is often used in multiple ways, and that it lacks a strong scientific basis. In this review, we argue that such a scientific basis is necessary for the concept of recovery to have a significant long-term impact on the way that schizophrenia is understood and treated. The discussion focuses on key issues necessary to establish this scientific agenda, including: 1) differences in definitions of recovery and their implications for studying recovery processes and outcomes; 2) key research questions; 3) the implications of data from outcome studies for understanding what is possible for people diagnosed with schizophrenia; 4) factors that facilitate recovery processes and outcomes, and methods for studying these issues; and 5) recovery-oriented treatment, including issues raised by peer support. Additional conceptual issues that have not received sufficient attention in the literature are then noted, including the role of evidence-based practices in recovery-oriented care, recovery-oriented care for elderly people with schizophrenia, trauma treatment and trauma-informed care, and the role of hospitals in recovery-oriented treatment. Consideration of these issues may help to organize approaches to the study of recovery, and in doing so, improve the impact of recovery-based initiatives.

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Available from: Steven Silverstein, Jun 03, 2015
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    • "Researchers have suggested that recovery might be parsed into different domains. Resnick et al. (2004) and Silverstein and Bellack (2008), have proposed that recovery may involve objective phenomena, including the absence or remission of symptoms and psychosocial deficits and subjective phenomena, which involve changes in how persons feel about themselves. While research suggests that individuals with schizophrenia value subjective and objective domains of recovery (Kuhnigk et al., 2012), research concerning the relationship of objective and subjective domains of recovery has been equivocal. "
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    ABSTRACT: Recovery from schizophrenia involves both subjective elements such as self-appraised wellness and objective elements such as symptom remission. Less is known about how they interact. To explore this issue, this study examined the relationship over the course of 1 year of four assessments of symptoms with four assessments of self-reports of subjective aspects of recovery. Participants were 101 outpatients with schizophrenia. Symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) while subjective recovery was assessed with the Recovery Assessment Scale (RAS). Separate Pearson׳s or Spearman׳s rank׳s correlation coefficients, calculated at all four measurement points, revealed the total symptom score was linked with lower levels of overall self-recovery at all four measurement points. The PANSS emotional discomfort subscale was linked with self-reported recovery at all four measurement points. RAS subscales linked to PANSS total symptoms at every time point were Personal confidence and hope, Goal and success orientation, and No domination by symptoms. Results are consistent with conceptualizations of recovery as a complex process and suggest that while there may be identifiably different domains, changes in subjective and objective domains may influence one another. Published by Elsevier Ireland Ltd.
    03/2015; 228(1). DOI:10.1016/j.psychres.2015.03.013
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    • "Currently, NICE guidelines for psychosis offer anti-psychotics as first-line treatment with individualized Cognitive Behavioural Therapy (CBT) being offered secondary to this (NICE 2014), which is clearly at odds to the Open Dialogue approach . Moreover, the traditional medical approach which underpins our current services views mental health recovery as an individualised approach dependent on symptom change which is quite contradictory to the Open Dialogue approach (Silverstein and Bellack 2008). Open Dialogue will require a whole-systems collaborative approach to ensure that it is integrated meaningfully which will involve taking a step back from medical treatment. "
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    ABSTRACT: Open Dialogue is a model of mental health services that originated in Finland and has since, been taken up in trial teams worldwide. As this is a relatively unknown approach in the UK, it is important to tentatively explore perspectives of NHS staff and service-users. Sixty-one Open Dialogue conference attendees, both staff and service-users, were recruited for this study. A feedback questionnaire was administered to determine the extent to which they believed the key tenets of Open Dialogue were important to service user care, and the extent to which they existed within current NHS services. Analysis of data demonstrated a strong consensus on the importance of the key principles of Open Dialogue for mental health care and also moderate disagreement that these principles exist within current NHS service provision. The Open Dialogue principles may offer a useful framework in order to develop services in a clinically meaningful way.
    Community Mental Health Journal 02/2015; DOI:10.1007/s10597-015-9849-5 · 1.03 Impact Factor
    • "It occurs through ongoing transactions between an individual and his or her world as a continuing process of change which is not illness focused (Onken et al., 2007; Slade, 2009). Recovery has been also understood as a vision, a philosophy, a process, an attitude, a life orientation, an outcome and a set of outcomes (Silverstein and Bellack, 2008). "
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    ABSTRACT: The Stages of Recovery Instrument (STORI; Andresen et al., 2006) was used among 110 patients with psychosis. Recovery stages relationship with attribution, the way of experiencing illness and its phase and symptoms were analyzed. The samples were drawn from treatment facility including in-patient unit. The subgroups of recovering patients were identified: moratorium (27%), awareness (32%), preparation (30%) and rebuilding (11%). The achievement of higher stages of the recovery was correlated with: less severe symptoms of psychosis (with the exception of anxiety and depression, which have no impact on the stages of recovery), medical attribution (I am ill), integrative attitude toward the experience of psychosis, and the absence of involuntary hospitalizations. The logistic regression analysis model indicated the independent significance of the medical attribution, the integrating attitude toward psychotic experience and the remission of symptoms. Other clinical variables and social characteristics did not differentiate between the stages of recovery in any significant way. No juxtaposition as such was found between the processes of recovery and being ill, but rather a complementary relation. Recovery has been found to be enhanced by the remission of psychotic symptoms, medical attribution and integrative attitude toward the experience of psychotic crisis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 12/2014; 225(3). DOI:10.1016/j.psychres.2014.11.036 · 2.68 Impact Factor
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