Recovery in Psychosis from a Service User Perspective: A Systematic Review and Thematic Synthesis of Current Qualitative Evidence

There is a growing number of qualitative accounts regarding recovery from psychosis from a service user perspective. The aim of this study was to conduct a systematic review of these qualitative accounts. A thematic synthesis was utilised to synthesise and analyse seventeen studies included in the review. Studies were included if they used a qualitative methodology to explore service users’ experiences of recovery from psychosis as a primary research question. All included studies were subjected to a quality assessment. The analysis outlined three subordinate themes: the recovery journey, facilitators of recovery (e.g. faith and spirituality, personal agency and hope), and barriers to recovery (e.g. stigma and discrimination, negative effects of mental health services and medication). Recovery is an idiosyncratic process but includes key components which are important to people who experience psychosis. These should be explored within clinical practice

Improving Access to Mental Health Care in an Orthodox Jewish Community: A Critical Reflection Upon the Accommodation of Otherness

The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an Orthodox Jewish community in the North West of England

Public perceptions of stigma towards people with schizophrenia, depression, and anxiety

Stigma is one of the greatest challenges facing people with a psychiatric diagnosis. They are widely stigmatised by the general public in the western world. The aim of this study was to examine public stigma attitudes towards schizophrenia, depression and anxiety. The Office of National Statistics (ONS) 2008 opinions survey (n=1070) was utilised. Percentage of endorsements for stigma items were initially compared to the previous 1998 and 2003 databases. Overall stigma attitudes had decreased (from 1998 to 2008) but increased since 2003. A principal components factor analysis identified that stigma attitudes have the same three factors structure across all diagnoses; negative stereotypes, patient blame and inability to recover. Schizophrenia was significantly associated with the most negative stereotypes, least blamed and viewed as least likely to recover compared to anxiety and depression. Public and individualised interventions that target diagnostic variability in stigma attitudes need to be developed and examined in future research

Innovative approaches to hallucinations in psychosis and affective disorders: A focus on noninvasive brain stimulation interventions

Auditory verbal hallucinations (AVHs) are defined as verbal perceptions without an objective provoking external stimulus. AVHs are core symptoms of schizophrenia and psychotic spectrum disorders and have a wide prevalence in other severe psychiatric disorders including affective disorders and substance-use disorders. Despite adequate pharmacological treatment, AVHs can persist over the long-term course of these disorders in a significant percentage of patients, causing significant individual impairment. Noninvasive brain stimulation interventions represent a new frontier in the investigation and development of novel treatment options for both schizophrenia and psychotic spectrum disorders. In particular, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have been used in the treatment of AVHs in the last two decades. These techniques have the common feature of delivering electrical energy to the brain from an external source, as happens with tDCS, or through the induction of magnetic fields, as the case of repetitive TMS. The electrical stimulation is aimed to produce an excitation or inhibition of specific functional neuro-circuits that are involved in the pathogenesis of AVHs. In this chapter, we summarized main evidence in relation to the therapeutic use of the above-mentioned approaches in patients with AVHs, with specific attention to the recommendations of available international guidelines. Current major limitations and possible future perspectives are discussed as well