Background
Method
Design of the study
Participants and recruitment
Interviews
Analysis
Results
Overview
Symptom-related outcomes | |
➢ Safety
d
| ➢ Fear/distress/pain
d
➢ Insight
d
|
Quality of life | |
➢ Stigma [63]c
| |
Functional outcomes | |
➢ Life milestones
c
| |
Personal recovery | |
➢ Accepting help/support from others [67]d
➢ Learning about (& managing/monitoring) illness/treatment/services [68]d
➢ Vulnerability/sensitivity
d
| ➢ Taking responsibility/decision-making [65]d
➢ Participating in life-enriching activities [66]c
➢ Personality/temperament
d
|
Physical health and lifestyle | |
➢ Exercise/physical activity
c
| ➢ Diet/weight
d
|
➢ Alcohol/drugs/smoking
c
| ➢ Routine
c
➢ Sleepc
|
Satisfaction with treatment | |
➢ Satisfaction with medication [70]c
| ➢ Satisfaction with therapeutic relationship [71]d
|
Symptom-related outcomes (Table 2)
Symptom-related outcomes | |
Safety (of self/others)
| |
• ‘Her behaviour became so risky in a way, and it was so difficult with her at home.’ [C50] | |
• ‘When he’s psychotic… he’s a danger to himself and he could be a danger to other people.’ [C26&27] | |
• ‘You’re at risk the whole time and a bit more vulnerable.’ [C07] | |
Fear/distress/pain
| |
• ‘It’s an effort and it’s almost a pain, it’s almost like a physical pain for him to stay normal.’ [C09] | |
• ‘I know that he’s distressed by the psychosis. You know he’s seeing things that are really awful… | |
• ‘If I look back, when medication was introduced [um] he probably was less distressed.’ [C24] | |
• ‘I think the worst thing was that… why should he have so much suffering?’ [C13] | |
Insight
| |
• ‘He’s doing very well at the moment although he’s in hospital. But the reason is that he has total insight… He knows what’s real… that has been the biggest progress.’ [C07] | |
• ‘To recognise that it’s his illness that’s giving him his thoughts, that’s giving him his voices.’ [C09] | |
• ‘She knows the difference between a paranoid thought and quote, a normal thought. So she knows when these thoughts are coming… and can begin to tackle them.’ [C22] | |
• ‘He’s come to the realisation that he does need an anti-psychotic.’ [C11] | |
Quality of life | |
Social acceptability
| |
• ‘[Medication allows her] to behave appropriately and you know [um]… in family situations.’ [C04&05] | |
• ‘Medication’s allowing him to be in the community and it’s allowing the community to be safe.’ [C12] | |
• ‘Unusual behaviour. Is there anything that can be done about that?’ [C20] |
‘It's great for it to be diagnosed, to be put on your medication and you're safe’ [C41]
‘He was absolutely intimidated by his environment… he felt frightened and threatened’ [C25]
‘He can rationalise…although he hears the voices he has a sense of reality.’ [C40]
Quality of life (Table 2)
‘[When] he's not taking his medication, he occasionally offends people in the street’ [C25]
Functional outcomes (Table 3)
‘I think he missed out all his twenties and thirties so maybe catching up in some ways.’ [C03]
‘The worst time that we've had was… when he was so unwell he didn’t go out the house for a year’ [C24]
Personal recovery (Table 3)
Functional outcomes | |
Life milestones
| |
• ‘He said [um], “I’m grown up now Mum,” and he didn’t see me for a long time… as though he’s struck out to be an adult… but he wanted to start where he left off when he was a teenager.’ [C03] | |
• ‘He wants to get married; he’d love to have children… you know he wants to have the life that everybody else has and he didn’t see himself not having that life and he’s like forty now and it’s like, you know, where have those twenty years gone when I should have been doing all this.’ [C32&33] | |
• ‘Bear in mind she’s still, almost her development stopped when she was 17 as an adult.’ [C38] | |
Getting out
| |
• ‘He’s been able to go out because before, he was frightened to go out not only because of what was out there, but because inside himself he couldn’t actually get out the door.’ [C06] | |
• ‘For three years she didn’t really do anything, she just, for three years she was just at home… sleeping a lot and watching tele and not going out and generally not living.’ [C19] | |
Pets
| |
• ‘He’d said… “I can’t manage myself let alone a dog”… it’s only recently that he said, “Oh yeah I think I’m up to having a dog,” so that’s a really good step forward.’ [C14&15] | |
• ‘He loved the kitten but I thought he can look after the kitten… but he wouldn’t, he wouldn’t look after it, he just loved it. It’s a cat now and he still loves it but he still won’t look after it.’ [C51] | |
Personal Recovery | |
Personality/temperament
| |
• ‘He’s much easier when he’s on medication, he’s much more like himself and [um], oh god when he’s not on it I have to watch every word I say.’ [C12] | |
• ‘I could see beneath his anxious anxiety and still his distress and everything, that there he was, my son that I knew whereas I’d lost sight of it completely before… I began to see the [1] that I knew before he became ill. He got his sense of humour back… I began to see his own personality coming back.’ [C09] | |
• ‘Becoming more friendly, becoming more co-operative… more considerate, thoughtful.’ [C03] | |
Vulnerability/sensitivity
| |
• ‘He’s very sensitive, very, very sensitive… he gets very stressed doesn’t he.’ [C14&15] | |
• ‘Until the stress was sort of plonked upon him and then the medication wasn’t quite enough.’ [C23] | |
• ‘It was times of stress and things…whether things went wrong then we’d get the paranoia then... he can’t take any stress that’s the thing.’ [C32&33] |
‘He reverted to his old self. You could reason with him, you could have a laugh with him’ [C46]
‘Although he seems fairly even I don’t think it would take a huge amount to kick him over the edge.’ [C06]
Physical health and lifestyle (Table 4)
Physical Health and Lifestyle |
---|
Exercise/physical activity and diet/weight
|
• ‘He was having plans. He said, “I need to go swimming, I want to get fit and I want to go swimming.” He wouldn’t go into the swimming pool because there are other people there.’ [C51] |
• ‘The only pleasure he had in life in the end, after being institutionalised and losing all the interests that he’d got… was eating you know.. I’ll send out for a pizza, that’ll be nice and I’ll watch a DVD and that’s about as…and a couple cans of lager and that’s about as normal as things got for him really…’ [C46] |
• ‘He can actually go down now and buy fresh fruit and vegetables… He couldn’t make decisions; [um] he didn’t know what food to eat… He didn’t have a fridge.’ [C25] |
• ‘She got anorexic, she wasn’t eating at all; she wasn’t drinking because she thought the water was contaminated. Physically she was going downhill because she wasn’t eating or drinking.’ [C14&15] |
Alcohol/drugs/smoking
|
• ‘He was self-medicating with alcohol. For quite a long while… he actually stopped drinking. And that helped a lot of things and it helped with the medication and generally with his mood.’ [C40] |
• ‘Once they’ve become established, or on a working medication, they don’t need the cannabis. Maybe it’s they don’t need it, maybe that they’ve become well enough in order to have insight to know that it’s harmful to them.’ [C10] |
• ‘She’s a confirmed smoker… It’s the least of our problems I think, you know.’ [C04&05] |
Routine
|
• I feel a lot better now he’s at college because he has to get up, he has to go out, he’s got something to do. So that’s really good because it’s horrible to watch somebody doing nothing all day.’ [C21] |
• ‘The only reason that [1]‘s working now… is because of this family… have made her do things and she’s living proof that if you get into a routine you can do things.’ [C38] |
• ‘He has some physical problems with sleeping. His sleeping is a little erratic. He might not sleep very well at night but he catches up during the day. So his life balance is different to probably you or I. But he manages that in his way now.’ [C40] |
• ‘They need a reason to get up, need a reason to get up in the morning’ [C28] |
‘On such a high dose… of a sedating medication. Motivation is just not there’. [C46]
‘She was drinking herself to sleep, I think, mostly because she had recurrent nightmares, and day time nightmares’ [C50]