Qualitative investigation of targets for and barriers to interventions to prevent psychosis relapse

BMC Psychiatry

Richard Drake¹  Fiona Lobban³  Christine Barrowclough²  Emily Eisner² 

[1] Institute of Brain Behaviour and Mental Health, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK;Clinical Psychology Department, Zochonis Building (2nd Floor), University of Manchester, Oxford Road, Manchester M13 9PL, UK;Division of Health Research, Spectrum Centre for Mental Health Research, Furness building, University of Lancaster, Lancaster LA1 4YW, UK

关键词: Qualitative;    Intervention;    Prodrome;    Basic symptoms;    Early signs;    Schizophrenia;    Psychosis;    Relapse;   

Others  :  1123462
DOI  :  10.1186/1471-244X-14-201

 received in 2014-02-12, accepted in 2014-07-09,  发布年份 2014

【 摘 要 】

Background

Early signs based relapse prevention interventions for psychosis show promise. In order to examine how they might be improved we sought to better understand the early relapse process, service users’ abilities to identify early signs, and any potential facilitators and barriers to early signs interventions.

Methods

Data from in-depth interviews with a convenience sample of service users with psychosis varying in gender, age, duration of mental health problems, and time since last relapse were analysed using a thematic approach. Interview transcripts were coded inductively and relationships between emerging themes were examined by the research team to provide a thorough synthesis of the data.

Results

Three central themes emerged from the analysis: 1) recognising risk factors (how risk factors were identified and linked to relapse, and reactions to such risk factors); 2) identifying early signs (issues related to both recognising and recalling signs of relapse); 3) reacting to deterioration (participants’ thoughts and feelings in response to early signs, including help seeking and its challenges).

Conclusions

There was considerable variation in the attention participants had paid to pre-relapse signs, the ease with which they were able to recall them, and their reactions to them. For many, there were substantial barriers to help seeking from services. A family or friend confidant was an important means of assistance, although the supportive presence of significant others was not always available. Based on these results, a number of recommendations about facilitating service users’ recognition of early signs and targeting potential accelerants of relapse are made.

【 授权许可】

   
2014 Eisner et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Robinson D, Woerner MG, Alvir JM, Bilder R, Goldman R, Geisler S, Koreen A, Sheitman B, Chakos M, Mayerhoff D, Lieberman JA: Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry 1999, 56:241-247.
• [2]Maclean C: An interpretative phenomenological analysis of service users’ perspectives and experiences of relapse in psychosis. D Clin Psy thesis: University of Glasgow, Institute of Health and Wellbeing; 2008.
• [3]Wiersma D, Nienhuis F, Slooff C, Giel R: Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort. Schizophr Bull 1998, 24:75-85.
• [4]Almond S, Knapp M, Francois C, Toumi M, Traolach B: Relapse in schizophrenia: costs, clinical outcomes and quality of life. Br J Psychiatry 2004, 184:346-51.
• [5]Eisner E, Drake R, Barrowclough C: Assessing early signs of relapse in psychosis: review and future directions. Clin Psychol Rev 2013, 33:637-653.
• [6]Campbell M, Fitzpatrick R, Haines A, Kinmonth A, Sandercock P, Spiegelhalter D, Tyrer P: Framework for design and evaluation of complex interventions to improve health. BMJ 2000, 321:694-696.
• [7]van Meijel B, van der Gaag M, Kahn RS, Grypdonck M: The practice of early recognition and early intervention to prevent psychotic relapse in patients with schizophrenia: an exploratory study. Part 1. J Psychiatr Ment Health Nurs 2002, 9:347-355.
• [8]van Meijel B, van der Gaag M, Kahn RS, Grypdonck M: The practice of early recognition and early intervention to prevent psychotic relapse in patients with schizophrenia: an exploratory study: part 2. J Psychiatr Ment Health Nurs 2002, 9:357-363.
• [9]Koening M, Castillo MC, Urdapilleta I, Le Borgne P, Bouleau JH: Relapse in schizophrenia: an exploratory study of the joint conceptions of patients, parents and caregivers. Encéphale 2011, 37:207-216.
• [10]Lamberti JS: Seven keys to relapse prevention in schizophrenia. J Psychiatr Pract 2001, 7:253-259.
• [11]Beck A, Morrison T: Barriers to using early signs monitoring in a forensic population. J Mental Health 2002, 11:501-509.
• [12]Birchwood M, Spencer E, McGovern D: Schizophrenia: early warning signs. Adv Psychiatr Treat 2000, 6:93-101.
• [13]Baker C: The development of the self-care ability to detect early signs of relapse among individuals who have schizophrenia. Arch Psych Nurs 1995, 9:261-268.
• [14]Tong A, Sainsbury P, Craig J: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007, 19:349-357.
• [15]American Psychiatric Association: Diagnostic and statistical manual of mental disorders (DSM-IV). 4th edition. Washington, DC; 1994.
• [16]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 2006, 3:77-101.
• [17]International Pty Ltd QSR: NVivo qualitative data analysis software, Version 9. Melbourne; 2010.
• [18]World Health Organisation: ICD-10 classifications of mental and behavioural disorder: clinical descriptions and diagnostics guidelines. Geneva; 1992.
• [19]Garety P, Kuipers E, Fowler D, Freeman D, Bebbington P: A cognitive model of the positive symptoms of psychosis. Psychol Med 2001, 31:89-95.
• [20]Butzlaff RL, Hooley JM: Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry 1998, 55:547-552.
• [21]Brown WG, Birley JLT: Crises and life changes and the onset of schizophrenia. J Health Soc Behav 1968, 9:203-214.
• [22]Ventura J, Nuechterlein K, Lukoff D, Hardesty JP: A prospective study of stressful life events and schizophrenic relapse. J Abnorm Psychol 1998, 98:407-411.
• [23]Jablenky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, Bertelsen A: Schizophrenia: manifestations, incidence and course in different cultures a world health organization ten country study. Psychol Med 1992, 20(Suppl):1-97.
• [24]Alvarez-Jimenez A, Priede A, Hetrick SE, Bendall S, Killackey E, Parker AG, McGorry PD, Gleeson JF: Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Schizophr Res 2012, 189:116-128.
• [25]Lewis A: The psychopathology of insight. Br J Med Psychol 1934, 14:332-348.
• [26]David AS: Insight and psychosis. Br J Psychiatry 1990, 156:798-808.
• [27]Amador X, David A: Insight and psychosis. New York: Oxford University Press; 1997.
• [28]Cuesta MJ, Peralta V, Zaruela A: Reappraising insight in psychosis: multi-scale longitudinal study. Br J Psychiatry 2000, 177:233-240.
• [29]Hultman CM, Wieselgren IM, Ohman A: Relationships between social support, social coping and life events in the relapse of schizophrenic patients. Scand J Psychol 1997, 38:3-13.
• [30]Ko NY, Yeh ML, Hsu ST, Chung HH, Yen CF: Investigation of insight formation using narrative analyses of people with schizophrenia in remission. J Nerv Ment Dis 2006, 194:124-127.
• [31]Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Salanti G, Davis JM: Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 2012, 379:2063-2071.
• [32]Harrow M, Jobe TH: Does long-term treatment of schizophrenia with antipsychotic medications facilitate recovery? Schiz Bull 2013, 39:962-965.
• [33]Ho B, Andreasen N, Ziebell S, Pierson R, Magnotta V: Long-term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia. Arch Gen Psychiatry 2001, 68:128-137.
• [34]Birchwood M: Early intervention in psychotic relapse: cognitive approaches to detection and management. Behav Change 1995, 12:2-19.
• [35]Gumley A, White C, Power K: An Interacting cognitive subsystems model of relapse and the course of psychosis. Clin Psychol Psychother 1999, 6:261-278.
• [36]Gumley A, O’Grady M, McNay L, Reilly J, Power K, Norrie J: Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychol Med 2003, 33:419-431.
• [37]Thompson K, McGorry P, Harrigan S: Recovery style and outcome in first-episode psychosis. Schizophr Res 2003, 62:31-36.
• [38]McGlashen T, Levy S, Carpenter W: Integration and sealing over: clinically distinct recovery styles from schizophrenia. Arch Gen Psychiatry 1975, 32:1269-1272.
• [39]Tait L, Birchwood M, Trower P: Predicting engagement with services for psychosis: insight, symptoms and recovery style. Br J Psychiatry 2003, 182:123-128.
• [40]Gumley A, Power K: Is targeting cognitive therapy during relapse in psychosis feasible? Behav Cogn Psychoth 2000, 28:161-174.
• [41]White R, Bebbington P, Pearson J, Johnson S, Ellis D: The social context of insight in schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2000, 35:500-507.
• [42]Phillips LJ, Francey SM, Edwards J, McMurray N: Strategies used by psychotic individuals to cope with life stress and symptoms of illness: a systematic review. Anxiety Stress Coping 2009, 22:371-410.
• [43]Lysaker PH, Bryson GJ, Marks K, Grieg TC, Bell MD: Coping style in schizophrenia: associations with neurocognitive deficits and personality. Schizophr Bull 2004, 30:113-121.
• [44]Lysaker PH, Wilt MA, Plascak-Hallberg CD, Brenner CA, Clements C: Personality dimensions in schizophrenia: associations with symptoms and coping. J Nerv Ment Dis 2003, 191:80-86.
• [45]Hofstetter JR, Lysaker PH, Mayeda A: Quality of sleep in patients with schizophrenia is associated with quality of life and coping. BMC Psychiatry 2005, 5:13-18.
• [46]Berry K, Barrowclough C, Byrne J, Purandare N: Coping strategies and social support in old age psychosis. Soc Psychiatry Psychiatr Epidemiol 2006, 41:280-284.
• [47]Macdonald EM, Pica S, McDonald S, Hayes RL, Baglioni JAJ: Stress and coping in early psychosis: role of symptoms, self-efficacy and social support in coping with stress. Br J Psychiatry 1998, 172:122-127.
• [48]Drake RJ, Clifford HJ, Akhtar A, Lewis S: Causes and consequences of duration of untreated psychosis in schizophrenia. Br J Psychiatry 2000, 177:511-515.
• [49]Morgan C, Abdul-Al R, Lappin JM, Jones P, Fearon P, Leese M, Croudace T, Morgan K, Dazzan P, Craig T, Leff J, Murray R: Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study. Br J Psychiatry 2006, 189:446-452.
• [50]Garety PA, Fowler DG, Freeman D, Bebbington P, Dunn G, Kuipers E: Cognitive–behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised controlled trial. Br J Psychiatry 2008, 192:412-423.
• [51]Australasian Centre for Policing Research: Mental Illness in the community: the role of the police. Marden; 2006.
• [52]Fry AJ, O’Riordan DP, Geanellos R: Social control agents or front-line carers for people with mental health problems: police and mental health services in Sydney, Australia. Health Soc Care Community 2002, 10:277-286.
• [53]Cochran S, Deane MW, Borum R: Improving police response to mentally ill people. Psychiatr Serv 2000, 51:1315-1316.
• [54]O’Callaghan E, Turner N, Renwick L, Jackson D, Sutton M, Foley SD, McWilliams S, Behan C, Fetherstone A, Kinsella A: First episode psychosis and the trail to secondary care: help-seeking and health-system delays. Soc Psychiat Epidemiol 2010, 453:81-91.
• [55]Bechard-Evans L, Schmitz N, Abadi S, Joober R, King S, Malls A: Determinants of help-seeking and system related components of delay in the treatment of first episode psychosis. Schizophr Res 2007, 96:206-214.
• [56]Tankskanen S, Morant N, Hinton M, Lloyd-Evans B, Crosby M, Killaspy H, Raine R, Pillings S, Johnson S: Service user and carer experiences of seeking help for a first episode of psychosis: a UK qualitative study. BMC Psychiatry 2011, 11:157-168.
• [57]Brunet K, Birchwood M, Lester H, Thronhill K: Delays in mental health services and duration of untreated psychosis. Psychiatr Bull 2007, 31:408-410.
• [58]Schultze-Lutter F, Ruhrmann S, Fusar-Poli P, Bechdolf A, Schimmelmann B, Klosterkotter J: Basic symptoms and the prediction of first-episode psychosis. Curr Pharm Des 2012, 18:351-357.
• [59]Bechdolf A, Schultze-Lutter F, Klosterkötter J: Self-experienced vulnerability, prodromal symptoms and coping strategies preceding schizophrenic and depressive relapses. Eur Psychiatry 2012, 17:384-393.
• [60]Pharoah F, Mari JJ, Rathbone J, Wong W: Family intervention for schizophrenia. 2010. [Cochrane database of systematic reviews, Volume 12] Art. No, CD00088. doi:10.1002/14651858.CD000088.pub3
• [61]Berry K, Barrowclough C, Wearden A: Attachment theory: a framework for understanding symptoms and interpersonal relationships in psychosis. Behav Res Ther 2007, 46:1275-1282.