Psychiatric Rehabilitation Journal最新文献

This article discusses the personal experiences of the parents regarding their child's medication journey. Parents can play a vital role in their child's overall mental well-being, ensuring they receive the care and support they need. To navigate these difficult circumstances, it is crucial for parents to maintain open lines of communication with their child as well as with the health care professionals involved in their care. Professionals should be aware that parents' perspectives toward mental health medication can evolve over time, influenced by the experiences and challenges faced by both child and family. Excluding parents from their child's treatment limits the potential for a comprehensive and holistic treatment approach. By recognizing the value of parental input, health care professionals can create a collaborative environment that maximizes the chances of finding the most suitable treatment strategy. It is important for health care professionals to engage families in a respectful and empathetic manner, recognizing the challenges they face. Providing them with the necessary support and guidance can help reduce feelings of helplessness and ensure their active involvement in their child's mental health journey (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Though the psychiatric field has primarily focused on medication and symptom amelioration via medication "adherence," contemporary approaches that incorporate recovery-oriented care and shared decision-making (SDM) could provide a more holistic and effective approach to serving individuals experiencing psychosis. This article explores the implementation of such innovative and collaborative practices while highlighting their benefits and challenges. Furthermore, it aims to offer practical implementations of SDM in prescribing practices.

Method: This article presents innovative strategies for prescribing antipsychotics utilizing SDM and recovery-oriented care approaches for those who experience psychosis. The study explores the clinical applications of these approaches within an inpatient psychiatric setting.

Results: The article emphasizes the numerous challenges for those who experience psychosis in adhering to antipsychotic medication and proposes a recovery-oriented approach facilitated by SDM. It emphasizes the importance of therapeutic alliance and collaboration while providing practical clinical applications of this approach.

Conclusions and implications for practice: The article advocates for collaborative approaches in antipsychotic prescribing, such as SDM and recovery-oriented care, to support those experiencing psychosis in constructing a life of meaning as they define it, including in how they choose to take medications. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The prevalence of the medical model in the field of mental health care has undoubtedly contributed to significant scientific progress. However, it is important to recognize that it may not represent the sole perspective for comprehending mental distress. Rather than endorsing particular paradigms, I advocate for a pluralistic approach that empowers individuals to discover their unique narratives, the stories that may save them. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: To examine the evidence and practice of antipsychotic dose reduction from the lens of biomedical ethics (specifically principlism) to support evidence-based practice and patient choice and self-determination.

Methods: An overview of the evidence from randomized controlled trials of antipsychotic dose reduction versus maintenance is presented. This is followed by a theoretical examination of the four key biomedical ethical principles of autonomy, nonmaleficence, beneficence, and justice and how they apply in the case of antipsychotic dose reduction.

Results: Existing clinical trial research is dominated by relapse as the primary outcome, with dose reduction associated with a higher risk of relapse than maintenance. Few studies have measured other patient-centered outcomes but have shown preliminary evidence for superior cognitive functioning, lower negative symptoms, and better functioning following dose reduction. Respect for autonomy is a cornerstone of psychiatric rehabilitation, and this includes the right of people to choose to reduce or discontinue antipsychotic medication. Reduced capacity for treatment decision making can be supported. Autonomy and appraisal of nonmaleficence and beneficence associated with dose reduction can be facilitated through shared or supported decision making. Clinicians should continue to strive for justice through the fair allocation of resources to support all people who request antipsychotic dose reduction.

Conclusions and implications for practice: Clinicians have a responsibility to balance the four core ethical principles to the best of their ability when supporting a person in their recovery journey. Exploring, trialing, and supporting antipsychotic dose reduction may be part of this process if that is the patient's choice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Personalized dose optimization is desirable to improve subjective well-being and support rehabilitation. Therefore, N = 1 trials investigating tools to self-manage functional outcomes during dose optimization are necessary. The aim of this pilot study was to determine in two N = 1 trials whether an experience sampling method (ESM) smartphone app could be used to monitor and detect changes in subjective well-being and psychotic experiences during and after dose reduction.

Method: Two participants with a psychotic disorder in remission underwent gradual dose reduction under a longitudinal self-monitoring paradigm, accompanied by regular clinical monitoring by the attending physician. Subjective well-being was monitored with an (ESM) app through momentary affective experience (positive and negative affect) and physical well-being (tiredness, feeling unwell, and pain). Momentary psychotic experiences were assessed with four items. Time-series linear regression models were used to detect changes in reduction phases compared to baseline.

Results: Whereas significant improvements in subjective well-being and psychotic experiences during dose reduction were detected in one participant, the opposite was demonstrated for the other participant, showing worsened subjective well-being and increased psychotic experiences in the reduction phase compared to baseline.

Conclusions and implications for practice: Self-monitoring with an ESM smartphone app offers a tool for detecting changes in subjective well-being and psychotic experiences during antipsychotic dose reduction. In this way, ESM may increase an individual's sense of control and empowerment. It may further facilitate dose optimization and shared decision-making at an individual level, which is required considering the high heterogeneity in psychotic disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Most individuals in recovery are likely to attempt discontinuing their prescribed medication at least once. The collection of articles in this special issue uses research with quantitative and qualitative methods, reviews of the literature, conceptualization of theory, and first-person accounts from various perspectives to begin to shift the field of psychiatric rehabilitation from a narrow focus on symptom reduction and a fear-driven emphasis on medication adherence to a new perspective in which dilemmas and strong feelings about medication use are commonplace. We issue a call to action for training psychiatric rehabilitation practitioners, who often have the most direct and frequent interactions with people in recovery, to explore their clients' experiences with using medication and its impact on a range of life domains. Rehabilitation, recovery, and medication have ongoing mutual influences and require an inclusive, multidimensional framework that integrates complex ongoing interactions between personal, societal, and biological processes and assures that treatment decisions are in alignment with recovery goals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A brief autoethnographic commentary that describes the harms of a pervasive emphasis on medications and medication adherence in the treatment of schizophrenia, including within "best practice" early psychosis programs. The narrative emphasizes the extent to which, in spite of endless rhetoric of person-centered, recovery-oriented care, the reality remains that medication-centric treatment tends to dominate clinical services and programs, fueling the objectification and alienation of service users, and ultimately, in all too many cases, disengagement. The author's personal experiences are provided as an illustration of the potentially devastating impacts that a narrow and rigid focus on medications (and medicalized clinical relationships) can have. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The current guidelines recommend continuation of antipsychotic medication for a minimum of at least 1 year following a first episode of psychosis (FEP). There have been several trials investigating whether early dose reduction or cessation leads to improved functional outcomes. The aim of this study was to explore the experience of consenting to and participating in a randomized controlled trial (RCT) of antipsychotic medication cessation.

Method: Five participants in the Reduce trial-an RCT evaluating early antipsychotic medication dose reduction/cessation following FEP-aged 22-24 years completed a semistructured qualitative interview following the RCT. Interpretive phenomenological analysis was undertaken to understand the key themes.

Results: A superordinate theme was derived from interviews: the Liminal Space of FEP and treatment. Themes within the Liminal Space included: rejection versus identification with psychosis, medication as symbolic of illness versus wellness, embodiment of wellness and illness with medication, medication as symbolic of independence versus dependence, discovery of independence when autonomously choosing medication, the Reduce trial offered safety to navigate the liminal space, and self-exploration versus altruism.

Conclusions and implications for practice: The experience and treatment of FEP involves young people feeling torn between multiple, competing perspectives, demands, and priorities. Participation in an RCT exploring dose reduction provided additional supports contributing to the perception of greater safety to navigate their own experiences of treatment that was appropriate for them. When treatment is experienced as collaborative, involves shared decision making and support, other than medication, young people feel more equipped to navigate the liminal space. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The COVID-19 pandemic had a profound impact on the mental health of individuals with serious mental illness, with restricting social gatherings and limiting access to essential community and psychosocial support services. For programs like clubhouses, adapting typically in-person programming to online settings led to the creation of virtual clubhouse programming that persists at many sites even after reopening. Although it has been documented how clubhouses adapted their programming online, it has not been investigated at the individual level how those programs were utilized over time, by different member cohorts, and how they persist in comparison to one another.

Method: The present article presents descriptive and inferential statistics, analysis of variance, and secondary trend analysis of the Fountain House clubhouse in-person and virtual engagements of three member cohorts who enrolled in either three time periods before pandemic restrictions (the prior cohort), during pandemic restrictions (the pandemic cohort), and after lockdown restrictions (the reopening cohort).

Result: Initial findings show that the prior cohort sustained their overall rate of engagement across time periods. The pandemic cohort had a significantly higher rate of engagement than the prior cohort within the during period but demonstrated a significant decrease in engagement rate between the during and after period. Prior and pandemic cohorts had statistically similar virtual and in-person engagement ratios in the after period, but the reopen cohort differed significantly with a predominant ratio of in-person engagements.

Conclusions and implications for practice: Member engagement trends within in-person and virtual offerings across the three different pandemic related time periods indicate important considerations for the sustainability and innovation of clubhouse virtual programming. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The theory of social practice describes a therapeutic community process for people living with serious mental illness, while the methods involve engaging people to become collaborators and contributors to a social environment. Confusion in the mental health field surrounding the applied methods of social practice-as occurring within the clubhouse model-has not been sufficiently addressed. This article aims to outline the methodology of social practice, as well as provide guidance on its practical application.

Methods: Specific constructs of social practice are defined, and empirical support is provided to emphasize how practices to support recovery are applied in the clubhouse.

Results: Five key elements of social practice-that is, transformational social design, engagement, relationship development, natural feedback and intervention, and transitional environments-are described. Practical examples of therapeutic techniques associated with each element are also provided.

Conclusions and implications for practice: Social practice addresses the social determinants of health by focusing on five key elements that support individual and community recovery. Here, we detail social practice techniques utilized in the clubhouse as a way of unifying theory, providing practical guidance to mental health professionals and improving the measurement of community as therapy for serious mental illness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).