51 Affective symptoms and personal recovery INTRODUCTION Severe mental illness (SMI) is a trans-diagnostic category of psychiatric disorders that have major and long-term impact on social and community functioning. Common disorders in SMI patients are schizophrenia, severe bipolar disorder, chronic depression and personality disorders (1, 2). Recovery of patients with SMI is an important focus of mental healthcare all across the world (3). Scientists and patients have, independently of each other, formulated a definition of recovery (4). These different forms of recovery are usually named clinical versus personal recovery. Traditionally, the primary treatment goal of patients with SMI is clinical recovery, which includes at least remission of symptoms, for instance 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) (5). Some studies have incorporated functional improvement in the definition of clinical recovery (6-8). Personal recovery is based on stories of patients with SMI showing that living a productive and satisfying life is possible despite ongoing symptoms (9). Anthony described this as: “the development of new meaning and purpose in one’s life, as one grows beyond the catastrophic effects of mental illness (10).” Based on narratives of individuals who have experienced mental illness, the following processes have been defined as being important in personal recovery: connectedness, hope, identity, meaning and empowerment. Together they form the acronym “CHIME” (11-13). The relationship between personal and clinical recovery has been a subject of debate (14). Some authors have suggested that clinical and personal recovery complement each other and should be equally acknowledged in clinical practice (15). It has also been suggested that clinical recovery is sometimes needed for personal recovery, but that this might not be the case for all patients (16). So far, the association between personal and clinical recovery has been investigated primarily in patients with a schizophrenia spectrum disorder. These studies show substantial variation in direction and magnitude of the association between clinical and personal recovery (17-19). In a recent meta-analysis it was shown that core symptoms of schizophrenia, i.e. delusions and hallucinations, only have a small to medium negative association with personal recovery, whereas affective symptoms have a stronger association with lower levels of personal recovery in patients with schizophrenia spectrum disorders (20). Studies in patients with affective disorders also suggest an important role for mood symptoms in personal recovery (21-23). 3
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