Measuring stages of recovery from psychosis.

BACKGROUND: Mental health consumers invite us to abandon the pathology model, which is tied to pessimism, and instead to embrace a model of personal recovery that goes beyond being free from symptoms, and involves self-management of the illness. The Stages of Recovery Instrument (STORI) is a measure developed from the perspective of consumers according to a conceptual five-stage model of recovery. AIMS: The main aim of this work was to study the psychometric properties of the STORI, but we also set out to compare the stages of recovery in our sample with the five-stage model in the sample with which the scale was developed. METHODS: Our sample consisted of 95 people diagnosed with schizophrenia-spectrum psychoses, with a mean age of 34.74 (SD=9.25). RESULTS: The STORI scores showed adequate psychometric properties in this sample. Cluster analysis indicated that the three-cluster model fitted the data better than the five-cluster model. Internal consistency of the STORI scores ranged between .83 and .87. STORI stages were associated with Recovery Styles Questionnaire scores. DISCUSSION: The results provide empirical validation of the STORI in other countries. Empirical evidence revealed that the stages of recovery found in our own and other clinical samples differ from those found in the samples with which the scale was developed.

Person-based contextual therapy applied to a complex case of schizophrenia.

BACKGROUND: Psychological therapies are becoming more and more important in schizophrenia, and not as mere adjuncts to medication. The psychotherapy of schizophrenia is taking on a new lease of life in the wake of person-based phenomenological and psychological developments. METHOD: The case in question was a complex one, with variegated symptomatology that had persisted over many years. Approaching the case from the perspective of person-based cognitive therapy allowed us to understand the psychotic symptoms in the biographical context and to apply a therapy focused on the patient's recovery of her sense of self and of life. RESULTS: At the end of the therapy and throughout the 12-month follow-up, the psychotic experiences had practically disappeared, or ceased to be disturbing, and the patient had become re-integrated in social life. CONCLUSIONS: Psychotic symptoms take on meaning in the biographical context. Adopting this perspective can aid the psychopathological explanation of the disorder and provide significant therapeutic help, more focused on recovery. Psychological therapy has shown itself to be viable in complex cases treated within the public-sector healthcare context.

Symptomatic and functional outcome in youth at ultra-high risk for psychosis: a longitudinal study.

The current report assesses the clinical, functioning and demographic data of a cohort enrolled in the P3 prevention program for psychosis; a Spanish National Health System and Ministry of Science funded program. Comparisons are made between those individuals who had converted to psychosis and those who had not at 3years after an average of 24 treatment sessions. Subjects included 61 participants meeting Structured Interview for Prodromal Syndromes criteria, with ages ranging from 17 to 31, and all meeting criteria for ultra-high risk of psychosis. Prospective follow-up data are reported for patients re-evaluated at 1 and 3years. At 1-year follow-up, the conversion rate to psychosis was 18%, but increased to 23% at 3-year follow-up. The converted sample was older than the non-converted sample and more likely to have higher ratings on subsyndromal psychotic (positive and disorganized), negative and general symptoms, and lower levels of functioning at baseline assessment. Analyses of change over time indicated a clear clinical improvement in both clinically stable patients and in those who showed a transient psychotic state over time. No gender differences in symptom or functioning levels at the three follow-up time points were found; however, the interactions among conversionxgenderxSOPS total scorextime points significantly reflect that the growth profiles of the four groups (no conversion males, no conversion females, conversion males and conversion females) in the SOPS total score are not parallel and that, consequently, the four groups involved different patterns of change over time, males experiencing faster and longer deterioration when psychotic symptoms arise.

Bases Clínicas para un Nuevo Modelo de Atención a las Psicosis / New Trends in Treatment for Psychosis

El objetivo de este artículo es resumir los conocimientos actuales sobre los tratamientos farmacológicos, psicosociales y otros procedimientos terapéuticos que se aplican a las psicosis. Si bien la medicación antipsicótica viene siendo el tratamiento de elección para las psicosis, y en especial para la esquizofrenia, la mejoría obtenida en los síntomas positivos es sólo moderada, y no ha demostrado eficacia en la mejora de los síntomas deficitarios persistentes. Incluso muchos pacientes continúan sufriendo los síntomas positivos y recaídas, especialmente cuando falla el cumplimiento del tratamiento farmacológico. Todo ello, pone en evidencia la necesidad de utilizar otros tratamientos adjuntivos, que ayuden al paciente a comprender y a manejar sus trastornos, a aliviar los síntomas, a mejorar el cumplimiento terapéutico, su funcionamiento social y su calidad de vida, y a resolver los problemas que no logran solución con la medicación. En la actualidad, el tratamiento de las psicosis requiere un enfoque amplio, multimodal, que incluya medicación, psicoterapia y tratamientos psicosociales (psicoeducación e intervenciones dirigidas a la solución de problemas, terapia cognitivo-conductual, rehabilitación cognitiva, entrenamiento en habilidades sociales y terapia asertiva comunitaria), así como ayuda en la búsqueda de alojamiento y recursos económicos que le permitan sobrevivir. En el futuro próximo, deberán desarrollarse intervenciones más adaptadas a las diferentes fases que presentan las psicosis (AU)

The purpose of this paper is to summarize our current knowledge about pharmacological, psychosocial, and other emerging treatments for psychoses. Although antipsychotic medications are the mainstay of treatment for psychoses, and particularly for schizophrenia, the degree of improvement in positive symptoms is moderate, and has no demonstrable efficacy against positive enduring or deficit negative symptoms. Indeed, many patients continue to suffer from persistent positive symptoms and relapses, particularly when they fail to adhere to prescribed medications. This underlines the need for additional treatment methods to help patients understand and manage their disorders, alleviate symptoms, improve adherence, social functioning and quality of life, and solve problems that do not fully respond to medication. Nowadays, comprehensive treatment entails a multi-modal approach, including medication, psychotherapy and social treatments (psychoeducation and coping-oriented interventions, cognitive behaviour therapy, cognitive remediation, social skills training and assertive community treatment), as well as assistance with housing and financial sustenance. In the foreseeable future, phase-specific interventions ought to be pplied to different stages of psychoses (AU)

Estado actual de la detección e intervención temprana en psicosis / No disponible

La posibilidad de intervenir precozmente en los trastornos psicóticos y alterar con ello el tradicional curso negativo de la enfermedad está generando un creciente interés en la comunidad científica y profesional. En este trabajo, presentamos el momento en que se encuentran las investigaciones y los desarrollos clínicos y de organización de servicios en las distintas fases iniciales de la enfermedad, describiendo tanto las nuevas formas de intervención como sus primeros y esperanzadores resultados (AU)

Early intervention in psychotic disorders in order to alter their typical negative course is nowadays creating a growing interest in the scientific and professional community. In this paper, the state of the art in research and clinical implementation, and the organization of services for the several early phases of the illness are presented; and new methods of intervention as well as the first and promising results are described (AU)

La investigación cognitiva del síndrome esquizofrénico / Cognitive research on schizophrenia syndrome

Se revisan las anomalías cognitivas observadas en la esquizofrenia y, específicamente,los déficit encontrados en diversos procesos automáticos y controlados: el filtrado dela información, la atención y vigilancia, la formación de conceptos y la memoria. Sedescriben también diversos paradigmas experimentales utilizados para el estudio de losprocesos ejecutivos centrales; y, finalmente, se describe un modelo cognitivo para lasconductas anormales y los síntomas clínicos de la esquizofrenia (delirios, desorganización,alucinaciones y la pérdida del sentimiento de identidad personal) que sugiere quepueden estar ligados a un trastorno básico de la percepción holística o la interpretaciónde contextos

This review provides a perspective of cognitive disturbances found in schizophreniaand, particularly, of deficits found in several automatic and controlled processes:information filtering, attention and vigilance, concept formation and memory. Severalexperimental paradigms employed in the study of central executive processes are alsodescribed; and, finally, a cognitive model of abnormal behaviours and clinical symptomsof schizophrenia (delusions, disorganization, hallucinations, and the loss of a sense ofpersonal identity) are outlined suggesting that they may be linked to a basic disturbancein comprehensive knowledge or context perception

Estado actual de la detección e intervención temprana en psicosis / State of the art of early detection and intervention in psychosis

La posibilidad de intervenir precozmente en los trastornos psicóticos y alterar conello el tradicional curso negativo de la enfermedad está generando un creciente interésen la comunidad científica y profesional. En este trabajo, presentamos el momento enque se encuentran las investigaciones y los desarrollos clínicos y de organización deservicios en las distintas fases iniciales de la enfermedad, describiendo tanto las nuevasformas de intervención como sus primeros y esperanzadores resultados

Early intervention in psychotic disorders in order to alter their typical negative courseis nowadays creating a growing interest in the scientific and professional community. Inthis paper, the state of the art in research and clinical implementation, and the organizationof services for the several early phases of the illness are presented; and new methods ofintervention as well as the first and promising results are described