RESUMEN
Both research and care have focused on first episodes of psychosis (FEPs) as a way to address the issue of early stages of schizophrenia and to reduce the duration of untreated psychosis. The objective of this study was to explore specifically the lived experience of FEP from the point of view of patients and their families by applying a metasynthetic approach, including a systematic review of the literature and analyses of qualitative studies on the subject. This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting FEP from the patient or family's perspective. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them. Thirty-eight articles were included, covering data from 554 participants (378 patients and 176 relatives). Three themes emerged from the analyses: (1) When and how does a FEP start? (2) What are its negative and positive aspects? (3) How do patients and families recount FEPs? Our results found important discrepancies between the experiences of patients and those of their families, especially regarding positive aspects. In light of the confusion reported by patients and notable in our results, we also discuss the gap between the name, FEP, and the lived experience of patients and family members in order to explore its practical implications.
Asunto(s)
Trastornos Psicóticos/diagnóstico , Investigación Cualitativa , Esquizofrenia/diagnóstico , Femenino , Humanos , Masculino , Trastornos Psicóticos/psicologíaRESUMEN
Reduced pain sensitivity is considered as a potential endophenotype of schizophrenia. Patient's motivation in pain experimental studies was neither assessed nor controlled. This study aimed to assess the effect of reward on pain in patients with schizophrenia compared to controls. Rewarded subjects showed higher pain threshold and tolerance compared to unrewarded subjects. Pain tolerance was significantly lower in patients than in controls when they were not rewarded. Reward resulted in an increase of pain tolerance with a higher manner in patients. This study suggests that better control of motivational aspects could improve assessment of pain sensitivity in schizophrenia.