Hope in Psychiatric Patients: An Observational Study in a Psychiatric Rehabilitation Centre (original) (raw)
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The Relationship Between the Hope Levels of Patients With Schizophrenia and Functional Recovery
Archives of Psychiatric Nursing, 2018
Schizophrenia is a severe mental disorder that starts at an early age and negatively affects the areas of emotion, thought and behavior, causing individuals to withdraw from their relationships and to retreat to their own unique world (Öztürk & Uluşahin, 2008). It is a serious chronic disease that causes delusions, hallucinations and disorganized catatonic behaviors and is found in every social and socioeconomic environment (Durmaz, 2011; Öztürk & Uluşahin, 2008). Schizophrenia affects individuals during the most functional period of their lives and leads to chronic and significant dissonance and conflict with their surroundings (Güneş, 2010). As a disease that causes more disability and has a poorer prognosis than other mental illnesses, the hopelessness of patients is one of the obstacles to healing during treatment (Gönüllüoğlu, 2011). For this reason, it is known as a disease that requires the healing and therapeutic effects of hope most (Lysaker, Campbell, & Johannesen, 2005). Jerome Frank described hope as "a power that gives an individual the feeling of well-being and motivation to act" (Akman & Korkut, 1993; Yıldırım, 2009). Hope increases motivation and prevents feelings of helplessness and pessimism that arise in cases of illness. It contributes to individuals' positive life energy and gives them the selfconfidence they need to reach their goals (Aslan, Sekman, & Vural, 2006; Aslan, Sekmen, Kömürcü, & Özet, 2007). Study results indicate that there is a decrease in the number of hospitalizations and an increase in treatment compliance rate and quality of life for schizophrenics with high levels of hope (Littrell, Herth, & Hinte, 1996; Lysaker et al., 2005). Adverse events such as increased suicide rate, reduced self-esteem, discontinued treatment and reduced functional recovery levels were found among patients with schizophrenia who are hopeless (Lysaker, Clements, Wright, Evans, & Marks, 2001; Lysaker, Roe, & Yanos, 2007). Schizophrenia also includes the ability to have the ideal functionality expected in areas such as functional recovery, health and treatment, as well as the ability of the patient to perform daily life activities, to do administrative and financial management, to provide the social environment necessary for the continuity of interpersonal relationships and professional functioning (Emiroğlu, Karadayı, Aydemir, & Üçok, 2009). Patients with schizophrenia have serious problems adapting to daily living skills, social relationships, communicating with their families and surroundings, and it is known that patients cannot revert to pre-disease functional levels even during their recovery (Emiroğlu et al., 2009; Kavak & Ekinci, 2014). For this reason, functional recovery in schizophrenia and integration of individuals into society are among the important therapeutic goals (Gönüllüoğlu, 2011). Study results indicate that the majority of patients with schizophrenia can lead satisfying and productive lives, take necessary precautions to protect their health, develop self-interest in treatment and have improved treatment compliance as their functional recovery levels increase. They also indicate that symptom recovery alone is not enough to recover from schizophrenia (Emiroğlu et al., 2009; Harding, Brooks, Ashikaga, Strauss, & Breier, 1987). For this reason, the level of hope, which is a necessary part of a satisfying and productive lifestyle for symptomatic and functional recovery, may be decisive (Emiroğlu et al., 2009). It is also important to note that initiatives to increase hope in schizophrenia treatment are a turning point in treatment and affect functional improvement positively (Öz, 2010; Yıldırım, 2009). It is of great importance that the health care team, especially psychiatric nurses, who frequently encounter schizophrenics and play an important role in their care, take appropriate initiatives to increase patients' hope (Kylmä, Juvakka, Nikkonen, Korhonen, & Isohanni, 2006). Nurses play a vital role in ensuring that patients realize their own values, set achievable goals and think positively (Öz, 2010). This study, which was intended to contribute to nursing practices and determine the problems of patients with schizophrenia, was conducted to determine the relationship between the hope levels of schizophrenia patients and functional recovery. It is thought that this data will fill an important gap in the literature. In addition, the study will provide a better understanding of hope and functional recovery in the treatment of schizophrenia and provide important data on this subject for future studies.
Hopelessness and its impact on rehabilitation outcome in schizophrenia –an exploratory study
Schizophrenia Research, 2000
The primary focus in contemporary psychiatry on symptoms and their neurobiological basis, although fundamentally important, is nevertheless incomplete. The long-term course and outcome of schizophrenia are determined not only by the disorder, but also by the interaction between the person and the disorder. Not only psychopathological symptoms but also cognitive variables such as negative self-concepts, low expectations and external loci of control can influence the patient's coping strategies and may lead to hopelessness and chronicity. Hopelessness here refers to a cognitive-affective state in which the patient perceives the disorder and its consequences to be beyond his control, feels helpless and has given up expecting to influence its course positively, thereby abandoning responsibility and active coping strategies. In a prospective study, we examined these relationships by using logistic regression in data from 46 schizophrenic outpatients who were participating in a vocational rehabilitation program. Negative selfconcepts, external loci of control, and depression correlated to a higher extent with depressive-resigned coping strategies than did schizophrenic symptoms. Thus, poor rehabilitation outcome may be predicted to a high degree by the presence of external loci of control, pessimistic outcome expectancies, negative symptoms, and depressive-resigned coping strategies. After having eliminated the influence of negative symptoms, external control beliefs still had significant predictive value for the outcome. Rehabilitation outcome in schizophrenic patients can be only partially predicted by negative symptoms; the other predictive factor is whether the patient has already given up or not.
Clinical and psychological correlates of two domains of hopelessness in schizophrenia
The Journal of Rehabilitation Research and Development, 2008
Hopelessness is a widely observed barrier to recovery from schizophrenia spectrum disorders. Yet little is known about how clinical, social, and psychological factors independently affect hope. Additionally, the relationships that exist between these factors and different kinds of hope are unclear. To explore both issues, we correlated two aspects of hope, expectations of the future and agency, with stigma, clinical symptoms, anxiety, and coping preferences in 143 persons with a schizophrenia spectrum disorder. Multiple regressions revealed that hope for the future was predicted by lesser alienation, lesser preference for ignoring stressors, and lesser emotional discomfort and negative symptoms, accounting for 43% of the variance. A greater sense of agency was linked to lesser endorsement of mental illness stereotypes, fewer negative symptoms, lesser social phobia, and lesser preference for ignoring stressors, accounting for 44% of the variance. Implications for research and interventions are discussed.
Hope and Life Orientation of Caregivers of Patients with Psychosis
Until recently, hospitals or psychiatric institutions have been in charge of caring for patients with psychosis however, off-late this role is being performed by the patient's family. Many studies have shown that care givers of patients experience a great deal of psychological stress and burden. Caregivers can cope with the burden and stress associated with caregiving by fostering the constructs of positive psychology. Hope and optimism are two such variables that ensure mental wellness and help in reducing the psychological stress and dysfunction associated with clinical disorders. Hope is a positive psychology construct which reflects people's motivation and ability to work toward personally significant goals. Optimism on the other hand is the tendency to believe that one will generally experience good versus bad outcomes in life. The objective of this study is to determine the levels of hope and optimism in caregivers for patients suffering from psychosis. A purposive sampling method was used to collect data from 35 caregivers from the Metropolitan cities of Hyderabad and Secunderabad. The Adult Hope Scale (Snyder et al., 1991) and the Life Orientation Test-Revised (Scheier & Carver, 1985) were used to measure the levels of hope and optimism respectively. The results indicate that the mean and SD of caregivers hope of men (M = 47.9, SD = 11.2) and women (M = 42.3, SD = 10.71) optimism of men (M = 13.2, SD = 3.34) and women (M =14.1, SD = 3.6) were not significantly different. The relationship between hope and optimism in caregivers of patients with psychosis is not significant. A t-test was performed to find out the difference in the hope and optimism experienced by men and women which was not found to be significant. Individuals with chronic mental illnesses, suffer from emotional disorders that are severe and long standing. They often have difficulty maintaining appropriate self-care, interpersonal relationships, work, education, and require prolonged assistance in order to live effectively in the community. It has been realised, that such illnesses affect not only the patient, but the entire family as well. Families often are a vital source of home care and support for the patient. Individuals of all ages are dependent on the informal care provided by one or more of the patient's relatives tocarry out many of the routine activities of daily life. A caregiver is a person who belongs to the patient's family, who takes care and is responsible for the patient and who commits most of his or her time to this task without any economic retribution (Dwyer, Lee, & Jankowski, 1995 as cited in Urizar, Maldonado & Castillo, 2009). Caregivers belong to the patient's informal support system and as such the patient is dependent on the caregiver to carry out most of his or her daily activities. Caregivers also play a critical role in providing guidance and aid to the patient.
Northern Clinics of Istanbul
P atients with serious mental disorders such as schizophrenia and similar psychotic disorders as well as mood disorders that highly debilitating due to their devastating effects on cognitive, managerial and social skills, or who are hospitalized for a long time, constitute the main target group of the community-based mental health model. Under this model, it is aimed to provide effective treatment in order to improve individual functioning, provide psychosocial support services, and ensure follow-up and treatment of patients in the environment they live in [1, 2]. Acceptance of the disease, hope, compliance with treatment, supportive environment and easy ABSTRACT OBJECTIVE: The main purpose of treatment and management in chronic mental disorders is to improve the quality of life (QOL). Hopelessness indicates a significant cognitive vulnerability that is associated with suicide risk. It is important for clinicians to have information about their patients' life satisfaction and spirituality. This study was conducted to determine hopelessness and life satisfaction in patients who received service from a community mental health center (CMHC). METHODS: This cross-sectional study was conducted with patients diagnosed with psychosis (n=66) and bipolar disorder (n=24) according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria, at a community mental health center serving in a hospital located in eastern Turkiye. Data was collected by a psychiatrist between January and May 2019 with face-to-face interviews, using a questionnaire, Beck Hopelessness Scale (BHS) and Satisfaction with Life Scale (SWLS). RESULTS: In the study, it was found that the mean BHS and SWLS scores of the patients did not differ significantly between the diagnosis groups (p>0.05). A moderately negative correlation was found between the patients' mean BHS and SWLS scores (rs=-0.450, p<0.001). In addition, it was determined that the hopelessness level of the secondary school graduates was low (p<0.05), the mean BHS score increased as the age and time from diagnosis of the patients increased (p<0.001), and there was a low negative correlation between the time from diagnosis and the mean SWLS score (rs:-0.208; p<0.05). CONCLUSION: In this study, it was found that the hopelessness level of the patients was low, their life satisfaction was moderate, and as the hopelessness level increased, their life satisfaction decreased. In addition, it was determined that the hopelessness and life satisfaction levels of the patients did not differ by to the diagnosis groups. It is extremely important for mental health professionals to consider aspects such as hope and life satisfaction, which are key in the recovery of patients.
Relation Between the Level of Hope and Functional Recovery Among Patients with Schizophrenia
Port Said Scientific Journal of Nursing
Background: Schizophrenia is a severe mental disorder interfering with an individual's capacity of clear thinking, managing emotions, making decisions, and relations with others. Aim was to investigate the relation between the hope and functional recovery among patients with schizophrenia. Subjects and method: Design: the study utilized a descriptive correlational research design was used. Setting: psychiatric in patient unit at port said psychiatric health hospital. Tools: The herth hope index (hhi); composed of 12 items adapted version of the herth hope scale (hhs). Tool II: the functional remission of general schizophrenia scale is a 19 items clinician-based questionnaire. In addition, to the demographic and clinical data sheet. Results: there was a statistically significant relation between hope level and the onset of treatment, number of hospitalization. Hope was shown to be significantly linked to gender, age, and family income. There was a statistically significant positive association between hope and functional remission. Conclusion: the study concluded that most of the studied patients have a high level of hope and functional recovery. In addition, it was found that there was a significant positive association between the total score of hope level of schizophrenic patients and the total score of functional recovery. Recommendation: the study recommended that hope-instilling programs and psychological counseling services have to be provided to schizophrenic patients. Moreover, social skills training programs must be carried out for patients with schizophrenia and cooperation with other institutions and organizations has to be achieved for enhancing their levels of professional functioning.
Hopelessness and first-episode psychosis: a longitudinal study
Acta Psychiatrica Scandinavica, 1997
Hopelessness has not been adequately studied in first-episode psychotic patients, although it is already present at the early stages, especially in schizophrenic patients. We have studied 96 neuroleptic-naive psychotic patients (49 schizophrenic patients and 47 other non-affective psychotic patients) over a period of 12 months after their first admission. The total score on the Hopelessness Scale (HS) at first admission was higher in the schizophrenic patients, and correlated with younger age and with negative symptoms. High HS scores at baseline predicted poor short-term outcome in schizophrenic patients, as evidenced by worse global functioning at the 12-month follow-up. These correlations were not observed in the other psychoses group. Our results suggest that young, severely affected schizophrenic patients who experience hopelessness might be at higher risk 1 of poor outcome.
Hopelessness in schizophrenia: the impact of symptoms and beliefs about illness
The Journal of nervous and mental disease, 2007
Risk factors for the development of hopelessness in schizophrenia remain poorly understood. This study investigated how psychiatric symptom levels and beliefs about illness might be linked to hopelessness in 100 patients with DSM-IV schizophrenia. Participants were assessed on the Beck Hopelessness Scale (BHS), the Calgary Depression Scale for Schizophrenia (CDSS), the Personal Beliefs about Illness Questionnaire (PBIQ), the Brief Psychiatric Rating Scale (BPRS), and the Scale for the Assessment of Negative Symptoms (SANS). Severe levels of hopelessness were found in 25% of the sample. There were significant differences between the hopeless and nonhopeless participants on the PBIQ subscales, SANS and BPRS. Differences on the PBIQ subscales remained significant when depression scores were controlled for. The total CDSS score, the "humiliating need to be marginalized" PBIQ subscale, and total BPRS score contributed significantly to a model accounting for 60% of the variance in hopelessness scores. Processes potentially implicated in the emergence of hopelessness in schizophrenia are discussed.
International journal of nursing studies, 2014
Hope has received attention as a central component of recovery from mental illness; however, most instruments measuring hope were developed outside the mental health field. To measure the effects of mental health programs on hope in people with schizophrenia, a specialized scale is needed. This study examined the psychometric properties of the newly developed 9-item Schizophrenia Hope Scale (SHS-9) designed to measure hope in individuals with schizophrenia. A descriptive survey design. Participants were recruited from three psychiatric hospitals and two community mental health centers in South Korea. A total of 347 individuals over age 18 with a DSM-IV diagnosis of schizophrenia, schizoaffective, or schizophrenia spectrum disorders (competent to provide written informed consent) participated in this study; 149 (94 men, 55 women) completed a preliminary scale consisting of 40 revised items, and 198 (110 men, 88 women) completed the second scale of 17 items. Scale items were first sel...
Exploring Hope in Individuals with Schizophrenia
International Journal of Psychosocial Rehabilitation, 2000
The purpose of this study was to assess the stability of hope, measured over a three-month period and to assess the effectiveness of a short--term intervention for individuals with long--standing schizophrenia. A before--after study design was used. The level of hopefulness was measured in thirty subjects, using the Miller Hope Scale. Eleven subjects self--selected to attend an inspirational lecture delivered by an individual who was coping well with schizophrenia. All 30 were tested again 2 and 6 weeks after the lecture. Subject bias was tested on each occasion using the Social Desirability Scale. The entire group had no significant change in hopefulness over time (F=1.86, df=2, p=.165). At the two post--test times, no significant difference was found between attenders and non--attenders on their level of hopefulness (F=.03, df=2, p=.968). The study group (x=142.30, SD=26.74) was 20 points lower on the Miller Hope Scale than the norms for healthy, normal adults (x=164.46, SD=17.65), but with larger variation in scores. This pilot study found that hope is a relatively stable phenomenon in individuals with long--standing schizophrenia. The relatively large variations in hopefulness indicates the need for future studies examining factors that influence this variation. The evaluation of the one time inspirational lecture found no long--term effect on hopefulness.