HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS Psychiatric Bulletin Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Related articles in BJP Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by TAIT, L. Articles by TROWER, P. Search for Related Content PubMed PubMed Citation Articles by TAIT, L. Articles by TROWER, P.

Predicting engagement with services for psychosis: insight, symptoms and recovery style

School of Psychology, University of Birmingham

MAX BIRCHWOOD, PhD, FBPsS

Early Intervention Service, Northern Birmingham Mental Health NHS Trust and School of Psychology, University of Birmingham

PETER TROWER, PhD

School of Psychology, University of Birmingham, UK

Correspondence: Lynda Tait, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. E-mail: lat726{at}bham.ac.uk

Declaration of interest None.

Background Treatment non-adherence and service disengagement are commonly attributed to impaired insight. There is evidence that recovery style (i.e. psychological adjustment) may underlie service engagement.

Aims We examined whether insight, psychotic symptoms or individuals' recovery style (‘integration’ v. ‘sealing-over’) predicts service engagement.

Method Fifty patients with schizophrenia were assessed during acute psychosis and at 3-month and 6-month follow-ups. Measures included recovery style, psychosis symptoms, insight and service engagement.

Results Sealing-over at 3 months following onset of an episode of psychosis predicted low service engagement at 6 months. Neither insight nor symptoms predicted engagement. The clear shift from integration to sealing-over within the first 3 months was independent of changes in symptoms or insight. Sealing-over between 3 and 6 months was associated with improvement in psychosis symptoms.

Conclusions Recovery style contributed more to engagement than did insight, appears to be dynamic in the short term and is orthogonal to insight. Overall, this study demonstrated the importance of addressing psychological adjustment to psychosis as well as illness status when investigating treatment engagement in people with psychosis.

Related articles in BJP:

Highlights of this issue

ELIZABETH WALSH
BJP 2003 182: 91-a7. [Full Text]  

This article has been cited by other articles:

				S. Mohamed, R. Rosenheck, J. McEvoy, M. Swartz, S. Stroup, and J. A. Lieberman Cross-sectional and Longitudinal Relationships Between Insight and Attitudes Toward Medication and Clinical Outcomes in Chronic Schizophrenia Schizophr Bull, June 26, 2008; (2008) sbn067v1. [Abstract] [Full Text] [PDF]

				T. M. Lincoln, E. Lullmann, and W. Rief Correlates and Long-Term Consequences of Poor Insight in Patients With Schizophrenia. A Systematic Review Schizophr Bull, November 1, 2007; 33(6): 1324 - 1342. [Abstract] [Full Text] [PDF]

				R. Chaplin How can clinicians help patients to take their psychotropic medication?: Invited commentary on... Why don't patients take their medicine? Advan. Psychiatr. Treat., September 1, 2007; 13(5): 347 - 349. [Abstract] [Full Text] [PDF]

				J. S. Lamberti Understanding and Preventing Criminal Recidivism Among Adults With Psychotic Disorders Psychiatr Serv, June 1, 2007; 58(6): 773 - 781. [Abstract] [Full Text] [PDF]

				P. H. Lysaker, D. Roe, and P. T. Yanos Toward Understanding the Insight Paradox: Internalized Stigma Moderates the Association Between Insight and Social Functioning, Hope, and Self-esteem Among People with Schizophrenia Spectrum Disorders Schizophr Bull, January 1, 2007; 33(1): 192 - 199. [Abstract] [Full Text] [PDF]

				S. PRIEBE, J. WATTS, M. CHASE, and A. MATANOV Processes of disengagement and engagement in assertive outreach patients: qualitative study The British Journal of Psychiatry, November 1, 2005; 187(5): 438 - 443. [Abstract] [Full Text] [PDF]

				L. Tait, M. Birchwood, and P. Trower Adapting to the challenge of psychosis: personal resilience and the use of sealing-over (avoidant) coping strategies The British Journal of Psychiatry, November 1, 2004; 185(5): 410 - 415. [Abstract] [Full Text] [PDF]

				G. Roberts and P. Wolfson The rediscovery of recovery: open to all Advan. Psychiatr. Treat., January 1, 2004; 10(1): 37 - 48. [Abstract] [Full Text] [PDF]