Qualitative investigation of targets for and barriers to interventions to prevent psychosis relapse.

Emily Eisner,Christine Barrowclough,Fiona Lobban,Richard Drake

doi:10.1186/1471-244x-14-201

Emily Eisner, Christine Barrowclough + Show 2 more

Open Access

https://doi.org/10.1186/1471-244x-14-201

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Abstract

BackgroundEarly signs based relapse prevention interventions for psychosis show promise. In order to examine how they might be improved we sought to better understand the early relapse process, service users’ abilities to identify early signs, and any potential facilitators and barriers to early signs interventions.MethodsData from in-depth interviews with a convenience sample of service users with psychosis varying in gender, age, duration of mental health problems, and time since last relapse were analysed using a thematic approach. Interview transcripts were coded inductively and relationships between emerging themes were examined by the research team to provide a thorough synthesis of the data.ResultsThree central themes emerged from the analysis: 1) recognising risk factors (how risk factors were identified and linked to relapse, and reactions to such risk factors); 2) identifying early signs (issues related to both recognising and recalling signs of relapse); 3) reacting to deterioration (participants’ thoughts and feelings in response to early signs, including help seeking and its challenges).ConclusionsThere was considerable variation in the attention participants had paid to pre-relapse signs, the ease with which they were able to recall them, and their reactions to them. For many, there were substantial barriers to help seeking from services. A family or friend confidant was an important means of assistance, although the supportive presence of significant others was not always available. Based on these results, a number of recommendations about facilitating service users’ recognition of early signs and targeting potential accelerants of relapse are made.

Highlights

Signs based relapse prevention interventions for psychosis show promise
Recognising risk factors captures participants’ accounts of significant events or stressors that occurred during the few months prior to their recent relapse, whether they saw them as risk factors for relapse, and their reactions to these experiences
Service users outlined changes in their internal experiences during the earliest phase of their recent deterioration in mental health that may be useful as early signs of relapse

Summary

Introduction

Signs based relapse prevention interventions for psychosis show promise. In order to examine how they might be improved we sought to better understand the early relapse process, service users’ abilities to identify early signs, and any potential facilitators and barriers to early signs interventions. The few existing qualitative studies [7,8,9] comprised interviews or focus groups with no more than ten participants from any one group (service users, staff or carers) and either conducted fairly superficial analyses (Alceste textual analysis [9]) or are unsubstantiated by quotations from participants [7,8] These studies make useful observations on the role of family members in early signs interventions [7,9], the need for therapeutic alliance with clinicians [8,9], the value of idiosyncratic early signs [7,9] and the challenges posed by negative symptoms or cognitive difficulties [8]. Unlike the current study it did not examine any one episode in detail but looked for patterns developing over successive episodes

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