Defining recovery in schizophrenia: A review of outcome studies.

Schizophrenia is a chronic disorder with a heterogenous course and different ways in which recovery is measured or perceived. Recovery in schizophrenia is a complex process that it can be defined either from a clinical perspective focused on sustained symptom and functional remission, or from a patient-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time. Therefore, this meta-analysis aimed to examine the relationship of global measures of subjective recovery with each of the components of clinical recovery such as symptom severity and functioning, in patients with schizophrenia spectrum disorders. The results showed that the association between different indicators of personal recovery and remission are weak and inverse (dIG+ = -0.18, z = -2.71, p < 0.01), however, this finding is not substantial according to the sensitivity indicators. With respect to functionality and personal recovery, there was a moderate relationship (dIG+ = 0.26, z = 7.894, p < 0.01) with adequate sensitivity indices. In addition, a low consensus exists between subjective measures that are more related to the patient's perspective and clinical measures based on experts and clinician's viewpoint.

Effects of Adherence to Pharmacological Treatment on the Recovery of Patients with Schizophrenia.

The aim of this study was to evaluate the effects of adherence to antipsychotic treatment on the recovery of patients with schizophrenia in northern Chile. One hundred and fifty-one patients diagnosed with schizophrenia completed the Drug Attitude Inventory (DAI-10), Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Recovery Assessment Scale (RAS-24), sociodemographic information, and clinical and treatment characteristics of patients with schizophrenia. Multivariate analysis with multiple linear regression was then performed to identify variables that were potentially associated with the recovery assessment (variable criterion). A significant association was found between adherence to antipsychotic medication and the Willing to Ask for Help dimension of Recovery (ß = 0.239, p = 0.005). Association of clinical and socio-demographic variables with recovery were identified: negative symptoms with Personal Confidence and Hope (ß = -0.341, p = 0.001) and Goal and Success Orientation (ß = -0.266, p = 0.014); cognitive symptoms with Willing to Ask for Help (ß = -0.305, p = 0.018) and no domination by symptoms (ß = -0.351, p = 0.005); marital status with reliance on others (ß = -0.181, p = 0.045); age with Personal Confidence and Hope (ß = -0.217, p = 0.021), Goal and Success Orientation (ß = -0.296, p = 0.003), and no domination by symptoms (ß = 0.214, p = 0.025). Adherence has a positive relationship with personal recovery in this sample of Chilean patients with schizophrenia.

Além da compulsão e da escolha: autonomia, temporalidade e recuperação pessoal / Beyond compulsion and choice: autonomy, temporality and personal recovery / Au-delà de la contrainte et du choix: autonomie, temporalité et rétablissement personnel / Mas allá de la compulsión y la elección: autonomía, temporalidad y recuperación

Este artigo discute a autonomia da pessoa que faz uso problemático de substâncias psicoativas (UPSP). Após o exame da ideia de autonomia de quem faz UPSP, a partir dos paradigmas médico, psicológico e moral, que oscilam entre as compreensões do uso como compulsão ou escolha, discute-se os aspectos psicopatológicos envolvidos no UPSP, em especial a experiência da temporalidade e suas implicações para o debate da autonomia dessas pessoas e para o seu processo de recuperação pessoal.

This paper discusses the autonomy of subjects engaged in substance misuse (SM). After examining the concept of autonomy of subjects engaged in SM, based on medical, psychological and moral paradigms that range between understanding SM either as a compulsion or a choice, we discuss the psychopathological aspects involved in SM, i.e., the experience of temporality and its implications regarding the autonomy of these subjects and their recovery process.

Cet article discute l'autonomie de personnes sujettes à l'utilisation problématique de substances psychoactives (UPSP). Après avoir élaboré la notion d'autonomie de ces sujets à partir de paradigmes médicaux, psychologiques et moraux qui comprennent l'UPSP soit comme une contrainte, soit comme un choix, on discute les aspects psychopathologiques liés à l'UPSP, en particulier l'expérience de la temporalité et ses implications pour le débat sur l'autonomie de ces personnes et leur processus de rétablissement.

Este artículo discute la autonomía de la persona que sufre con el consumo problemático de sustancias psicoactivas (CPSP). Después examinar la idea de autonomía en quien tiene un CPSP, a partir de los paradigmas médico, psicológico y moral, que oscilan entre las comprensiones del uso como compulsión o elección, se discuten los aspectos psicopatológicos involucrados en el CPSP, en especial en la experiencia de la temporalidad, y sus implicaciones para el debate de la autonomía de esas personas y para su proceso de recuperación personal.

Dieser Artikel ergründet die Autonomie von Personen, die einen problematischen Gebrauch von psychoaktiven Stoffen machen. Wir analysieren den Begriff der Autonomie dieser Subjekte basierend auf medizinischen, psychologischen und moralischen Paradigmen, die den Drogenkonsum entweder als Zwang oder Wahl verstehen. Nachfolgend diskutieren wir dann die psychopathologischen Aspekte des Drogenkonsums, vornehmlich die Erfahrung der Temporalität und ihren Einfluss auf die Debatte über die Autonomie dieser Subjekte während ihres Rehabilitationsprozesses.

Peer support for people with mental illness / Suporte interpares na doença mental

Background Peer support is a mutual aid system based on the belief that someone who faced/overcome adversity can provide support, encouragement and guidance to those who experience similar situations. Objective: To conduct a systematic review that describes this concept and characterizes peer supporters, its practice and efficacy. Method: Research on ISI Web of Science, EBSCO Psychology and Behavioral Sciences Collection and Medline databases (from 2001 to December 2013) was conducted using as keywords “mental illness”, “mental health”, “psychiatric disability”, “mental health services”, combined with “peer support”, “mutual support”, “self-help groups”, “consumers as providers”, “peer-run services”, “peer-run programs” and “social support”. Results: We found 1,566 articles and the application of both the exclusion (studies with children, teenagers and elderly people; disease in comorbidity; peer support associated to physical illnesses or family members/caregivers) and the inclusion criteria (full text scientific papers, peer support or similar groups directed for schizophrenia, depression, bipolar or psychotic disorders) lead to 165 documents, where 22 were excluded due to repetition and 31 to incomplete text. We analyzed 112 documents, identifying as main peer support categories: characterization, peer supporter, practices and efficacy. Discussion Despite an increasing interest about this topic, there is no consensus, suggesting realizing more studies...

Contexto: O suporte interpares é um sistema de ajuda mútua baseado na crença de que alguém que enfrentou/superou adversidades pode oferecer apoio, encorajamento e orientação a outros que enfrentam situações similares. Objetivo: Realizar uma revisão sistemática que caracterize o suporte interpares como prática, analise a sua eficácia e caracterize os pares prestadores de suporte interpares. Método: Pesquisa nas bases de dados ISI Web of Science, EBSCO Psychology and Behavioral Sciences Collection e Medline (2001 a dezembro de 2013), utilizando as palavras-chave “mental illness”, “mental health”, “psychiatric disability”, “mental health services”, combinadas com “peer support”, “mutual support”, “self-help groups”, “consumers as providers”, “peer-run services”, “peer-run programs” e “social support”. Resultados: Encontraram-se 1.566 artigos e foram aplicados os critérios de exclusão (artigos com crianças, adolescentes e idosos; doença mental em comorbidade; suporte interpares em doenças físicas ou familiares/cuidadores) e de inclusão (revistas científicas com texto integral disponível; suporte interpares ou grupos similares dirigidos a esquizofrenia, depressão, transtorno bipolar e outras perturbações psicóticas), resultando em 165 documentos. Excluíram-se 22 por repetição e 31 por texto incompleto, resultando em 112, os quais se identificaram como principais categorias do suporte interpares: caracterização, prestador de suporte, práticas e eficácia. Conclusão: Existe interesse crescente pelo tema, embora alguns domínios não sejam consensuais, sugerindo necessidade de mais estudos...