Adult Attachment and Personal Recovery in Clients With a Psychotic Disorder

Background: Personal recovery has become a key objective in the treatment of clients with a psychotic disorder. So far it has been established that the two attachment dimensions, ie, anxious and avoidant, are negatively associated with subjective well-being, self-esteem and hope. This study is the first to explore whether attachment styles are related to personal recovery in this population. Aims: To study the effects of anxious and avoidant attachment on personal recovery in a population with a psychotic disorder. Method: This cross-sectional study is part of the UP's multicenter cohort study on recovery from psychotic disorders, in which 265 participants are currently included. Attachment was assessed using the Psychosis Attachment Measure, including the anxious and avoidant attachment dimensions. Personal recovery was measured using the Recovering Quality of Life-10 (ReQOL-10) and the Individual Recovery Outcomes Counter (I.ROC). Regression analysis was used to investigate the effect of attachment on personal recovery. Results: We found negative effects of the anxious attachment style on the total scores of the ReQoL-10 (b = -4.54, SE = 0.69, β = β0.37) and the I.ROC (b = -5.21, SE = 0.89, β = -0.32). Although there were also negative effects of the avoidant attachment style on the total scores of the ReQoL-10 (b = -3.08, SE = 0.93, β = -0.18) and the I.ROC (b = -4.24, SE = 1.24, β = -0.19), these were less pronounced. Conclusion: Results show that both forms of insecure attachment (anxious and avoidant) are related to poorer personal recovery in clients with a psychotic disorder.</p

Regional differences in the care and treatment of compulsory admissions in the Netherlands

BACKGROUND: In the Netherlands compulsory admissions are on the increase. However, there are regional differences even when demographic factors are taken into account. AIM: To find out whether there are regional differences in the type and duration of care given to detainees. METHOD: On the basis of case-register data for Gronigen, South Limburg, Utrecht and Rotterdam, we monitored the psychiatric history and aftercare followed emergency compulsory admissions and we analysed the differences between patient groups ('old acquaintances', 'newcomers' and 'passers-by'). RESULTS: Almost 60% of patients were well known to the mental health care service and had previously received psychiatric care. 85% of the patients were still receiving care three months after admission. Even when patient and admission characteristics were taken into account, there were still regional variations in the type and length of mental health care episodes before and after compulsory admission. CONCLUSION: The continuity of health care for emergency admissions in the context of the Dutch Mental Health Act varies from region to region. It remains to be seen whether the situation will change when the new Mental Health Act comes into force.</p

Personal Recovery in People With a Psychotic Disorder:A Systematic Review and Meta-Analysis of Associated Factors

Background: Personal recovery (PR) is a subjective, multidimensional concept, and quantitative research using PR as an outcome is rapidly increasing. This systematic review is intended to support the design of interventions that contribute to PR in psychotic disorders, by providing an overview of associated factors and their weighted importance to PR: clinical factors, social factors, and socio-demographic characteristics are included, and factors related to the concept of PR (organized into CHIME dimensions). Methods: A systematic literature search was conducted from inception to March 2020. Quantitative studies that had used a validated questionnaire assessing the concept of PR were included. Mean effect sizes for the relationship between PR-scale total scores and related factors were calculated using meta-analyses. Sources of heterogeneity were examined using meta-regression tests. Results: Forty-six studies, that used (a total of) eight PR measures, showed that in clinical factors, affective symptoms had a medium negative association with PR-scale total scores (r = −0.44, 95%CI −0.50 to −0.37), while positive, negative and general symptoms had small negative correlations. No association was found with neuro-cognition. Social factors (support, work and housing, and functioning) showed small positive correlations. Gender and age differences had barely been researched. Large associations were found for PR-scale total scores with the CHIME dimensions hope (r = 0.56, 95%CI 0.48–0.63), meaning in life (r = 0.48, 95%CI 0.38–0.58) and empowerment (r = 0.53, 95%CI 0.42–0.63); while medium associations were found with connectedness (r = 0.34, 95%CI 0.43–0.65) and identity (r = 0.43, 95%CI 0.35–0.50). Levels of heterogeneity were high, sources included: the variety of PR measures, variations in sample characteristics, publication bias, variations in outcome measures, and cultural differences. Discussion: Most interventions in mental healthcare aim to reduce symptoms and improve functioning. With regard to stimulating PR, these interventions may benefit from also focusing on enhancing hope, empowerment, and meaning in life. The strength of these findings is limited by the challenges of comparing separate CHIME dimensions with questionnaires assessing the concept of PR, and by the high levels of heterogeneity observed. Future research should focus on the interaction between elements of PR and clinical and social factors over time