Hopelessness and its impact on rehabilitation outcome in schizophrenia –an exploratory study (original) (raw)
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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.
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.
Neurocognitive, social and clinical correlates of two domains of hopelessness in schizophrenia
Schizophrenia Research, 2004
While hopelessness has been widely observed in schizophrenia and its clinical significance accepted, research has been equivocal regarding its relationship to symptoms and neurocognition. One possible reason for this is that different domains of hope have differential relationships to outcome. To explore this possibility, two aspects of hope, expectations of the future and motivation to persist were assessed along with neurocognition, personality, symptoms and social function among 52 persons in a post acute phase of schizophrenia. Multiple regressions revealed that neuroticism, verbal memory and income were each uniquely related to expectations of the future, accounting for almost one half of the variance ( F = 14.3, p < 0.0001). By contrast, neuroticism and social isolation were uniquely related to motivational hope ( F = 13.6, p < 0.0001), accounting for 35% of the variance. Positive and negative symptoms were unrelated to either form of hopelessness. Implications for research, and the development of interventions are discussed. D
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.
Psychiatria Danubina, 2013
Although the negative appraisals of the illness may be related to suicidal thinking and behaviours in schizophrenia, this has been insufficiently studied. The aim of this study was to analyze the relationship between schizophrenic patients' cognitions about their illness and past suicidal behaviours. The relationship between patients' beliefs about their illness with potential mediators of suicidal behaviours such as depressive symptoms, hopelessness and insight was also investigated. A group of 60 patients diagnosed with schizophrenia according to ICD-10 criteria belonging to a follow-up study were assessed one year after their last psychiatric admission. Psychopathological variables were assessed by the Calgary Depression Scale, Beck Hopelessness Scale and the first three items of the Scale to Assess Unawareness of Mental Disorder. The appraisals of the illness were assessed by the Personal Beliefs about Illness Questionnaire. Negative appraisals were associated with hopel...
Schizophrenia Research, 2006
While changes in self-experience have been suggested to be an important element of recovery from severe mental illness, little is known about how qualities of self-experience are linked with other indicators of health including objective measures such as symptoms profiles and subjective measures such as hope. To examine these issues the narratives of self and illness of 65 persons with schizophrenia spectrum disorder were obtained prior to entry into rehabilitation and rated using the Scale to Assess Narrative Development (STAND). STAND scores were then compared with concurrent assessments of hope assessed with the Beck Hopelessness Scale (BHS), psychosocial function using the Quality of Life Scale (QOLS) and symptom profile defined categorically using the Positive and Negative Syndrome Scale (PANSS). Results suggest that higher ratings of the STAND were associated with greater expectations of perseverance on the BHS and higher levels of psychosocial function on the QOL. Lower symptom profiles were similarly linked with higher STAND scores. Results suggest qualities of self-experience expressed within personal narratives are linked to symptom profiles and subjective assessments of health. Theoretical and clinical implications are discussed.
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.
International Journal of Behavioral Consultation and Therapy, 2009
Maladaptive styles of coping are believed to be a barrier to recovery from schizophrenia. In this study we obtained measures of coping for 133 persons with schizophrenia or schizoaffective disorder. A cluster analysis was then performed based on those scores and produced five distinctive coping profiles. These five groups were then compared on concurrent assessments of hope, self-esteem, symptoms and social function. Multivariate and univariate ANOVA revealed that the group with a coping profile that involved a preference for both considering and acting had significantly greater levels of hope and selfesteem than groups with the other four coping profiles (p<.05). The group with a preference for resigning had lesser hope, self-esteem and more depressive symptoms than another other group (p<.05).
Beck Hopelessness Scale: Exploring its Dimensionality in Patients with Schizophrenia
Psychiatric Quarterly, 2011
Hopelessness is a pre-eminent risk factor for suicide and non-fatal self-harm. Although the Beck Hopelessness Scale is often used for schizophrenia, its factor structure has been given relatively little consideration in this context. This study aimed to examine the reliability and validity of the Taiwanese version of the Beck Hopelessness Scale (BHS-T) in a chronic schizophrenia outpatient sample. One hundred and two (102) outpatients were evaluated using the translated Taiwanese version of the BHS (BHS-T), as well as several Beck-related symptom rating scales and the Positive and Negative Syndrome Scale (PANSS) for psycho-pathology. The patients were also evaluated for suicidal intent using the critical items of the Scale for Suicide Ideation (SSI) and suicide attempts. The psychometric properties of the BHS-T were also evaluated, including construct validity, internal consistency, test-retest reliability, convergence, and discriminative validity. The BHS-T showed good overall reliability and stability over time. This translated scale comprised a two-factor solution corresponding negative expectation and loss of motivation dimensions. Differences in mean hopelessness scores between participants with and without suicidal intent were significant. The results also indicated that, among individuals with schizophrenia, ''negative expectation in the future'' is more closely linked to suicide intent than ''loss of motivation for the future''. The BHS-T is a reliable and valid instrument for measuring the multi-dimensionality of hopelessness and may complement clinical suicidal risk assessments in individuals with schizophrenia.