180 Chapter 9 ENGLISH SUMMARY Transcending Illness: Personal Recovery in Psychosis The aim of the current thesis was to better understand the relationship between clinical and personal recovery in patients with psychosis and other severe mental illnesses (SMI). In medicine, recovery generally means: returning to a pre-existing state of health. In psychiatry and mental healthcare, clinical recovery refers to reduction or remission of symptoms and functional improvement. The concept of personal recovery has been developed by the patient movement and has been based on narratives of individuals who have experienced mental illness. It is about the development of new meaning and purpose in life as one grows beyond the effects of mental illness. This process does not necessarily mean a return to the same state as before, but is rather an adaptation to disruptive circumstances. It has also been stated that recovery transcends illness and is universally human, because it is about overcoming the drawbacks or catastrophes of life in general. In this thesis, firstly, we conducted a systematic review and meta-analysis of studies investigating the cross-sectional (i.e. at one point in time) relationship between clinical and personal recovery in patients with schizophrenia spectrum disorders (SSD). We found a negative association between symptom severity and personal recovery, however with a rather small effect-size. When comparing different symptom domains, affective symptoms (depression/anxiety) showed a more substantial association with personal recovery, than psychotic, i.e. positive or negative, symptoms. Similar associations were found in our study conducted at five flexible assertive community treatment (F-ACT) teams at Mentrum, part of Arkin Institute for Mental Health, in Amsterdam, the Netherlands. Of note, these teams offer treatment to patients with a broader range of severe mental illnesses, such as bipolar disorder, chronic depression or personality disorder, not only SSD. We prospectively investigated this sample and found that overall change in symptom severity explained less than one-third of the variance of change in personal recovery after three years. Again, change in depression/anxiety symptom severity showed the most substantial association with change in personal recovery. Also, only severity of depression/anxiety at baseline significantly predicted positive change in personal recovery over time. Subsequently, we interviewed 26 patients of the study at Mentrum to explore the subjective experience of clinical (i.e. medicalpsychiatric) treatment interventions in their personal recovery stories. Here we found that most clinical treatment interventions can have both positive and negative impact on personal recovery: receiving a diagnosis can lead to relief, but also to stigma; medication has positive effects, but side-effects impair personal recovery; hospitalization and coercive treatment can be helpful, but can also have a negative
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