Recover recovery style from psychosis: a psychometric evaluation of the German version of the Recovery Style Questionnaire (RSQ).

AIMS: The way an individual handles the experience of psychosis, the so-called 'recovery style', has been shown to substantially affect long-term outcomes. The Recovery Style Questionnaire (RSQ) measures this psychological dimension. The aim of this study was to provide a validation of the German version of the RSQ and to raise awareness for recovery-oriented approaches. METHODS: The RSQ was translated into German according to the guidelines of the WHO and patients were administered this questionnaire and measures of internalised stigma, psychotic symptoms, illness concept, empowerment, self-esteem and quality of life. Descriptive statistics were demonstrated to characterise the sample. Reliability was assessed in different forms: internal consistency, test-retest reliability and split-half reliability. Items were evaluated with descriptive data and item-total correlations. Convergent and discriminant validity were shown, and a confirmatory factor analysis was performed. In order to ameliorate the model, a post hoc model modification was done. RESULTS: The sample consisted of 138 patients diagnosed with schizophrenia spectrum disorders (mean age: 35.7 years; 53.6% men; mean duration of illness: 20.6 years) with a mean RSQ overall percentage of 66.12 (s.d. ± 17.43%), mainly representing the categories 'mixed picture' and 'tends towards integration'. The reliability of the RSQ was acceptable with a Cronbach's α of 0.741 and a test-retest coefficient of 0.502. Item-total correlations were not acceptable for 27 of 39 items. Moderate evidence for convergent validity of the RSQ was found. Confirmatory factor analysis revealed that the 13-factor model with 39 items originally proposed was partially poorly replicated in the present sample (χ2 ratio to degrees of freedom (χ2/df) of 1.732, Comparative Fit Index (CFI) of 0.585, Normed Fit Index (NFI) of 0.414, Tucker-Lewis Index (TLI) of 0.508, root mean square error of approximation (RMSEA) of 0.095). The RSQ was modified based on item-total correlations and path coefficients of the single items. The confirmatory factor analysis of the resulting one-factor model with 11 items showed adequate fit to the data (χ2/df of 1.562, CFI of 0.936, NFI of 0.847, TLI of 0.910, RMSEA of 0.083) and demonstrated good model fit. CONCLUSIONS: Despite partially insufficient psychometric data of the original RSQ, the concept of recovery style is beneficial to psychiatric research and clinical practice. The underlying idea is valuable, and the questionnaire needs further development. Therefore, a short version of the RSQ is proposed.

Insight, positive and negative symptoms, hope, depression and self-stigma: a comprehensive model of mutual influences in schizophrenia spectrum disorders.

Aims. Insight, positive and negative symptoms, hope, depression and self-stigma are relevant variables in schizophrenia spectrum disorders. So far, research on their mutual influences has been patchy. This study simultaneously tests the associations between these variables. Methods. A total of 284 people with schizophrenia spectrum disorders were assessed using the Schedule for the Assessment of Insight, Positive and Negative Syndrome Scale, Integrative Hope Scale, Centre for Epidemiological Studies Depression Scale and Internalized Stigma of Mental Illness scale. Path analysis was applied to test the hypothesized relationships between the variables. Results. Model support was excellent. Strong and mutual causal influences were confirmed between hope, depression and self-stigma. The model supported the assumption that insight diminishes hope and increases depression and self-stigma. While negative symptoms directly affected these three variables, reducing hope and increasing depression and self-stigma, positive symptoms did not. However, positive symptoms diminished self-stigma on a pathway via insight. Conclusions. This study provides a comprehensive synopsis of the relationships between six variables relevant for schizophrenia spectrum disorders. Research implications include the need to investigate determinants of consequences of insight, and the sequence of influences exerted by positive and negative symptoms. Clinical implications include the importance of interventions against self-stigma and of taking a contextualized approach to insight.

A qualitative study exploring experiences of discrimination associated with mental-health problems in Ireland.

AIMS: Stigma and discrimination related to mental-health problems impacts negatively on people's quality of life, help seeking behaviour and recovery trajectories. To date, the experience of discrimination by people with mental-health problems has not been systematically explored in the Republic of Ireland. This study aimed to explore the experience impact of discrimination as a consequence of being identified with a mental-health problem. METHODS: Transcripts of semi-structured interviews with 30 people about their experience of discrimination were subject to thematic analysis and presented in summary form. RESULTS: People volunteered accounts of discrimination which clustered around employment, personal relationships, business and finance, and health care. Common experiences included being discounted or discredited, being mocked or shunned and being inhibited or constrained by oneself and others. CONCLUSIONS: Qualitative research of this type may serve to illustrate the complexity of discrimination and the processes whereby stigma is internalised and may shape behaviour. Such an understanding may assist health practitioners reduce stigma, and identify and remediate the impact of discrimination.

The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia.

OBJECTIVE: The quality of life (QOL) of patients with schizophrenia has been found to be positively correlated with the social network and empowerment, and negatively correlated with stigma and depression. However, little is known about the way these variables impact on the QOL. The study aims to test the hypothesis that the social network, stigma and empowerment directly and indirectly by contributing to depression influence the QOL in patients with schizophrenia and schizoaffective disorders. METHOD: Data were collected on demographic and clinical variables, internalized stigma, perceived devaluation and discrimination, empowerment, control convictions, depression and QOL. Structural equation modelling (SEM) was applied to examine the impact of the above-mentioned constructs on QOL. RESULTS: The influences of the social network, stigma, empowerment and depression on QOL were supported by the SEM. A poor social network contributed to a lack of empowerment and stigma, which resulted in depression and, in turn, in poor QOL. Interestingly, however, the social network and stigma did not show a direct effect on QOL. CONCLUSION: Following a recovery approach in mental health services by focusing on the improvement of the social network, stigma reduction and especially on the development of personal strength has the potential to reduce depression in patients with psychosis and improving their QOL.

Pharmacophilia and pharmacophobia: determinants of patients' attitudes towards antipsychotic medication.

OBJECTIVE: To identify factors that influence attitudes towards psychopharmacological treatment in patients suffering from schizophrenia and schizoaffective psychoses. METHODS: Ninety-two participants in an outpatient psychoeducational program, classed as "pharmacophobic" or "pharmacophilic" according to the Drug Attitude Inventory scale, were compared with regard to sociodemographic variables, clinical characteristics, subjective deficit syndrome, illness concepts, knowledge, locus of control, and quality of life. RESULTS: The 59 pharmacophilic and the 33 pharmacophobic patients did not differ significantly with regard to most sociodemographic variables, symptoms, or classic personality traits such as locus of control, self-concept, and quality of life. The only differences concerned hospitalization history ( P < 0.05) and statements on the actual, subjective experience of desired and undesired effects of medication ( P < 0.01). CONCLUSIONS: The impact of subjective experiences with drug treatment on attitudes towards medication and compliance needs to be a main focus of interventions targeting attitudes towards pharmacological treatment.

Capgras syndrome and functional psychosis in 2 survivors of torture.

Functional psychosis has only rarely been described in context with extreme stressors, most studies focusing singularly on posttraumatic stress disorder symptoms. We report for the first time the case histories of 2 patients suffering from Capgras syndrome along with schizoaffective disorder and posttraumatic stress disorder after prior experience of prolonged torture. Interaction of personal life experience and psychiatric disorder are proposed as factors resulting in persistent changes in perception and affect.

["Because it concerns me"--patient-directed discharge letters]. / "Weil es mich betrifft"--direkt an Patientlnnen gerichtete Entlassungsbriefe.

PURPOSE: Evaluation of practicability and acceptance of discharge summaries addressed directly to patients after psychiatric hospitalisation. METHODS: Over a period of 3 months 65 patients got discharge summaries addressed directly to them. Doctors and patients--4 months after discharge--were asked to evaluate this procedure. RESULTS: Both doctors' and patients' acceptance and evaluation was very positive. Argumentations for this view were the need to give and get information and the impression that this procedure can enhance confidence and trust.

Psychiatric wills of mental health professionals: a survey of opinions regarding advance directives in psychiatry.

Psychiatric wills are advance directives for an eventual involuntary treatment in psychiatry. We attempted to determine psychiatric professionals' knowledge and opinion about this legal option and obtain their formulations of advance directives for themselves. A total of 101 psychiatric nurses and psychiatrists at the Department of Psychiatry of the University of Vienna responded to a questionnaire about psychiatric wills and anonymously drafted advance directives for themselves concerning psychiatric treatment in case of an acute psychosis. Fifty-four percent knew about this legal option, 55% considered it an appropriate legal possibility, and 29% considered it inappropriate. The study also found that 75% of respondents reject certain methods of therapy, e.g. 30% want to exclude the use of neuroleptic medications, and 46% reject ECT. We conclude that although there is little experience so far with advance directives for psychiatric patients, there is an interest and predominance of positive attitudes towards this legal option among mental health professionals. Concerning their preferences, professionals felt inclined to make very specific statements as to which available treatment strategies they would reject and which they would request for their treatment. This bodes well for the widespread use of advance directives in mental health settings.

Dimensions of quality of life and self-monitoring therapy with oral anticoagulants--still research or everyday practice?

In correlation with increased life expectancy of patients, quality of life (QOL) has become a factor of increasing interest by the patient himself and also of importance in health-care planning and recruitment of financial resources. In this context, self-monitoring of long-term anticoagulant treatment might be a strategy that could mean a step forward in health-related as well as general life satisfaction for patients participating in self-monitoring programs. Also, the new strategy of increased home-control of anticoagulant treatment illustrates the complexity of multiple factors that can lead to changes in the subjective feeling and objective aspects of QOL. Our intention in a pilot study was to probe the feasibility of QOL research and relevant factors of influence by retrospectively evaluating data from two groups of outpatients seen in a large treatment center. The high frequency (n = 8 in sample 2) of disturbed sleep as a simple screening indicator stresses the probable importance of undetected depression, which might require treatment and could confound research as to QOL. Instruments to measure QOL in oral anticoagulation self-monitoring should therefore be adapted to the heterogeneous structure of factors in the target population, and include psychological parameters, especially in regard to health-related locus of control and mood.