21 Clinical and personal recovery, a meta-analysis INTRODUCTION Recovery has become an increasingly important aspect of care in mental health services all over the world (1). Recovery-oriented practices have especially emerged for schizophrenia, which has traditionally been seen as a condition with an unfavorable course (2). Since the second half of the 20th-century patient organizations have challenged the assumption that people with schizophrenia cannot live a productive and satisfying life. Patients have emphasized that recovery can occur even when psychotic symptoms are persistent (3). Scientific- and patientbased influences have resulted in a clinical and a personal definition of recovery in schizophrenia (2). The clinical definition includes remission of symptoms and functional improvement. The Remission in Schizophrenia Working Group (RSWG) defines remission as improvements in core signs and symptoms to the extent that they are of such low intensity that they no longer interfere significantly with behavior (4). Operational criteria include a score of mild or less on specific items of a symptom scale over a 6-month period, eg, the Positive and Negative Syndrome Scale (PANSS) or the Brief Psychiatric Rating Scale (BPRS). The RSWG describes that recovery, besides being relatively free of disease-related psychopathology, implies the ability to function in the community, socially and vocationally. The RSWG states that recovery is a more demanding and longer-term phenomenon than remission and that remission is a necessary but not sufficient step toward recovery. Moreover, the RSWG writes that consensus regarding operational criteria for recovery, in particular, cognition or psychosocial functioning, was considered outside its scope, because more research is needed on this topic (4). Other authors have also included living independently, having friends (5) and scores of >65 on the Global Assessment of Functioning (GAF) to the criteria of clinical recovery (6). The patient-based definition of recovery has been developed based on narratives of individuals who have experienced mental illness (7, 8). Stories from the patient movement have shown that people with psychosis have the possibility of living a productive and satisfying life, despite ongoing symptoms (3). The most frequently cited patient-based definition is: “the development of new meaning and purpose in one’s life, as one grows beyond the catastrophic effects of mental illness (9).” Recovery from schizophrenia is not a uniform process but varies from person to person (10). The term personal recovery has been widely used in literature to describe the patientbased definition of recovery (11). Because personal recovery is different for every individual, it is hard to define common characteristics. Nonetheless, several authors have tried to capture important aspects of personal recovery in qualitative research. Andresen et al., by reviewing 2
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