Recovery is a multidimensional construct that can be defined either from a clinical perspective or from a consumer-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. We aimed to longitudinally examine the overlap and mutual distinctions between clinical and personal recovery. Of 1239 people with schizophrenia consecutively recruited from the FondaMental Advanced Centers of Expertise for SZ network, the 507 present at one-year did not differ from those lost to follow-up. Clinical recovery was defined as the combination of clinical remission and functional remission. Personal recovery was defined as being in the rebuilding or in the growth stage of the Stages of Recovery Instrument (STORI). Full recovery was defined as the combination of clinical recovery and personal recovery. First, we examined the factors at baseline associated with each aspect of recovery. Then, we conducted multivariable models on the correlates of stable clinical recovery, stable personal recovery, and stable full recovery after one year. At baseline, clinical recovery and personal recovery were characterized by distinct patterns of outcome (i.e. better objective outcomes but no difference in subjective outcomes for clinical recovery, the opposite pattern for personal recovery, and better overall outcomes for full recovery). We found that clinical recovery and personal recovery predicted each other over time (baseline personal recovery for stable clinical recovery at one year; P = .026, OR = 4.94 [1.30–23.0]; baseline clinical recovery for stable personal recovery at one year; P = .016, OR = 3.64 [1.31–11.2]). In short, given the interaction but also the degree of difference between clinical recovery and personal recovery, psychosocial treatment should target, beyond clinical recovery, subjective aspects such as personal recovery and depression to reach full recovery.
BackgroundCognitive impairments are extremely common in schizophrenia and strongly predict deficits in daily functioning, poor management of medication, and multiple hospitalizations. Cognitive remediation is recognized to have a positive impact on cognitive impairments by engaging preserved cognitive functions or by implementing environmental supports that sustain independent living.Velligan et al. [1] developed and tested a manualized intervention, called Cognitive Adaptation Training (CAT). In this program, trained mental health specialists implemented compensatory techniques such as environmental supports in the individual’s living environment in order to live more independently and achieve greater self-sufficiency.However, implementing this program requires a lot of professionals and time to maintain CAT effect. This type of intervention is not widely available in community care which may explain the large number of patients who are dependent on family members for daily living activities. Training family members in this form of intervention would be an appropriate way to resolve these issues. Family expressed a real interest in these types of home-support strategies that CAT offers. Recently, Kidd et al. [2] developed a CAT version for Families and created a manual accessible to people without any knowledge of cognitive deficits. This manual helps families to select specific cognitive-adaptative strategies with their relative to achieve targeted goals. This method has been translated in French.The aim of this study is to examine whether Web-based Family Cognitive Adaptation Training can improve functioning, medication adherence and negative symptoms for individuals with schizophrenia as well as reduce burden for the family members.Methods/DesignA total of 60 Dyads consisting of one caregiver and one supported individual with schizophrenia will be randomized to either Web-based family cognitive adaptation training or an internet-based control condition (psycho-education). The primary outcome measure will be the total score on the life skills profile. Secondary outcome measures will include the global score of the Zarit burden Interview, the PANSS negative score, the CAINS score, patient medication adherence, and patient and caregiver quality of life.DiscussionWe hope that this type of intervention could be developed in territorial areas where professionals are not trained to cognitive remediation and therefore substantially lower the barrier to the deployment of cognitive interventions with other psychosocial interventions for individuals with schizophrenia and their caregivers.Trial registration: ClinicalTrials.gov Identifier: NCT04173598. Registered on November 22th 2019
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