Guide Risk and Protective Factors in Schizophrenia: Towards a Conceptual Model of the Disease Process

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Are structural cerebral changes progressive in schizophrenia? Discussion: developmental disorders of the brain. Obstetric complications, maternal psychopathology, and the risk of psychosis. Migration and the social epidemiology of schizophrenia. Environmental risk factors of psychosis. Gattaz, W. Risk factors for schizophrenia in childhood and youth. Association between cognitive and behavioral functioning, non-psychotic psychiatric diagnoses, and drug abuse in adolescence, with later hospitalization for schizophrenia.

Specificity of basic symptoms in early onset schizophrenia. Resch, P. Parzer, L. Poustka, E. Koch, H. Meng, D. Discussion: indicators of schizophrenia in childhood and adolescence. Predicting the onset of schizophrenia. The early course of schizophrenia. Maurer, W. Testing models of the early course of schizophrenia.

Schultze-lutter, W. Discussion: psychopathological predictors of onset and course of schizophrenia. Neuroprotection in schizophrenia - What does it mean? Neuroprotective effects of estrogens in the central nervous system: mechanisms of action. Results of two controlled studies on estrogen: avenue to neuroprotection in schizophrenia.

Kulkarni, A. Castella, M.

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Downey, S. White, J. Taffe, P. Fitzgerald et al. Family interventions: empirical evidence of efficacy and open questions. Cognitive-behavior therapy in the treatment of schizophrenia. Coping and social support as protective factors. Discussion: protective interventions in schizophrenia. Risk and protective factors in schizophrenia. In the patient FG, researchers took into consideration the listening, processing and conversational skills of the individuals with schizophrenia.

The researchers asked concise questions, and rephrased or repeated these as necessary [ 51 ]. Also, questions evolved from the general to the particular, i. Focus groups were conducted in Spanish, and were audio recorded. Permission for these recordings was sought before the recordings began. A thematic, inductive analysis was performed [ 46 , 53 ]. This type of analysis is congruent with the design by covering the multiple perspectives of the case study participants [ 47 ]. Thematic analysis [ 53 , 54 ] consisted of identifying the most descriptive content in order to obtain meaningful units, and subsequently reduce and identify the most common meaningful groups.

In this manner, groups of meaningful units were formed, i. This thematic analysis process was performed separately upon the non-participant observations, informal interviews, FGs, diaries and personal letters. Subsequently, joint meetings were held to combine the results of the analysis. Also, the data collection and analysis procedures were discussed during these meetings. In the case of differences in opinion, theme identification was performed based on consensus among the research team members. Subsequently, the research team held joint meetings to show, combine, integrate and identify final themes [ 47 ].

No data analysis software was used.

Indicated Prevention of Schizophrenia

The techniques performed and the application procedures used to control trustworthiness are described in Table 3. These methods to increase rigor are compatible with case-study designs [ 45 , 57 ]. Moreover, we considered special ethical considerations for the students and patients with schizophrenia S11 File. Fifty-one participants were included in the study. See Table 1 for the sociodemographic profile of the participants.

Risk And Protective Factors In Schizophrenia Towards A Conceptual Model Of The Disease Process

Fifteen patients 11 male were included with a mean age of Nine female students participated, with an average age of The hospital professionals had a mean age of Ten parents of students and six teachers of students participated, aged, on average Teachers had Five themes emerged from the material analyzed: a learning to live together, b the perception of the illness and of the mentally ill, c change, d a test and an opportunity, e discharge and readmission.

We included the narratives taken directly from the data collection regarding the five themes identified in this study.

Both groups described participating together during all activities games, cooking, cleaning , first formally programmed groups and later informally during spare time. Another common point raised was that both groups were able to learn from one another. During the cohousing initiative, the students and patients shared time, space and performed activities together that favored the exchange of experiences. Many of the conversations were focused on how they were living, what they did before being hospitalized or before participating in the study, or regarding their past and their family.

Together with this exchange, the psychologist performed sessions with the patients and the students, both separately and together, in order to facilitate the adaptation, emotional control and management of conflicts. As a result, they learnt together. The students described a change in the way they view those who are ill. Also, not just because you are mentally ill are you going to be bad. There are many normal people who are much worse. They diagnose you and you are now mentally ill. The society does not provide a real image of patients, they project a distorted and grotesque image: they are always the bad ones, the crazy ones, bringing up thoughts of asylums, or as people who may harm you, etc.

This is what is projected in films, in the news etc. Students remarked that a change and a transformation had taken place within them. How can I say that my life is difficult? Furthermore, for these students, living with patients was like seeing themselves in a mirror. Parent focus group. Parents focus group. She was an expert in trying to die and each time she got better at it… she told me all the ways to do it Student focus group.

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The key has been the experience, what they have gone through is etched in their memories forever. The cohousing experience was perceived as both a test and an opportunity for patients. It was a way of demonstrating that they are prepared for discharge. Also, it was perceived as a test to be able to live with others outside the hospital, and discover their limits. In this test, there were risks of failure, and uncertainties, because not everything is controlled i.

A test that you can be successful with or mess up… I was very unsure regarding what would happen… would I be able to do it? Patient focus group. Cohousing represents a step closer towards being discharged. However, a flip side to discharge exists. During the cohousing experience, one of the patients suffered a crisis and had to be taken to the hospital and abandon the cohousing program.

As a result, patients began to narrate their own past experiences of being admitted to hospital and suffering relapses. Patients acknowledged that, in previous readmissions, they felt they had not done all that was in their hands to remain discharged from hospital, i. The most relevant results of this study include: students and patients participating and learning together; a slim barrier between health and disease, a transformation taking place in students, regarding their self-perception, patients testing their ability to live outside the hospital, and discharge, experienced as both a liberation and a difficulty, whereas relapse and readmission are experienced as a failure.

Our results show how, during the cohousing experience, patients and students relate with each other, learning and overcoming barriers together. A number of programs have been developed to promote the contact between adolescents and patients in order to break the stigma, improve the understanding of the mentally ill, promote mental health among the young and prevent substance abuse [ 30 — 32 ].

Previous studies [ 30 , 31 ] have suggested that contact-based education on mental illnesses may be an important component of diversity training for adolescents, ideally before stereotypes of mental illness begin to become established. In circumstances of equal status and common goals, greater contact with members of a stigmatized group i. Conrad et al. However, with the design used in this study, we cannot describe how this change of perspective has occurred, nor whether this change will be long-lasting. However, these findings do seem to be relevant for participants who have taken part in the experience.

The students also perceived that the overall society continues to reject mental illness. The coverage is scarce and the news analyzed often contains stigmatizing contents that highlight the negative stereotype. Our results reveal that the experience of patients living together with students has provided an opportunity to overcome barriers, helping patients to demonstrate their ability to live outside the hospital, relate with healthy people, share, work on common goals, and establish friendships.

Anderson [ 40 ] described how schizophrenia patients know that they are mentally ill and that they make a special effort to test reality by asserting their autonomy. Furthermore, they see reality as providing an opportunity to analyze themselves. Recovery-oriented practice focuses on the recovery of such factors as hope, empowerment, meaning, identity, and connectedness [ 10 ]. Also, previous studies [ 66 , 67 ] reported that mentally ill people understand recovery as becoming more capable and more autonomous in activities that allow them to integrate into the community, such as having a job.

On the other hand, prior studies show that schizophrenia patients, by keeping occupied and working with other people, develop the ability to interact, and improve their social relations, [ 67 , 68 ] as well as building friendships [ 69 ]. Previous studies [ 70 , 71 ] have pointed out how these interventions must be established in order to help people who suffer from persistent and severe mental health problems that limit their daily life and their ability to fulfil their personal objectives, i.

Our results showed that patients feel that their discharge is both a source of liberation as well as a risk. The fear of failure, of having a relapse, and facing readmission is very real. At the SJPH, before hospital discharge, patients receive home support, living with other patients in the same apartment under regular supervision. However, there is no intermediate step between being at hospital and receiving supported housing. Previous studies [ 72 , 73 ] have highlighted the difficulty of managing life following discharge, together with feelings of loneliness.

Patients want to return to their life prior to hospitalization, however, they become frustrated as they are unable to make the appropriate decisions to achieve this. Previous studies [ 42 , 73 ] have shown that relapses may represent a danger that will accompany the patient for the rest of their life outside the hospital, making it difficult to make plans for the future, as individuals with schizophrenia must always remain vigilant.

In this study, the impetus toward acceptance of the risk of relapse, and adaptation was provided by dangerous events substance abuse, and avoiding medication that forced participants to perceive the risks of ignoring the impact of the illness on their lives. The experience of relapse is highly individual and risk factors exist, as well as protectors.

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Sariah et al. Within the risk factors, these authors describe: the lack of adherence to medication and taking drugs personal , the absence of family support and stressful events environmental [ 74 ]. On the other hand, the protective factors are: adherence to medication, employment, religion personal , family support, support from other patients, visits and professional follow-up, and a therapeutic relationship with other professionals [ 74 ]. There are differences between the personal perception of the recovery of the patients themselves and the clinical recovery decrease of symptoms expected by professionals, which may condition the expected treatment results [ 73 , 75 ].

It is important to note that, in case studies, different units of analysis are included which enable us to understand the phenomenon in greater depth, as well as serving as a triangulation technique to control the quality of the study and provide information from another perspective that is different to that of the patients [ 47 , 56 , 57 ].

Indeed, prior studies [ 73 , 77 ] have shown how the family can experience situations of emotional exhaustion. Second, the study included a small number of participants and the cohousing experience was limited to four days. Third, this study has not quantified the efficacy of the cohousing experience.

The qualitative nature of this study meant that the focus was on describing the experiences of the participants and, therefore, these findings cannot be generalized. Also, we are lacking longitudinal data or a comparison group. Finally, there were differences regarding the age and gender of the participants who participated in the cohousing experience.

In order to control for this difference, within the cohousing experience, mixed groups were formed haphazardly, to avoid grouping by age or sex. Our findings can help us to better understand the relationships and perceptions between people with mental illness and those without. There are different forms of supported housing such as Housing First [ 78 ], Permanent Supportive Housing [ 79 , 80 ], and Recovery Housing [ 81 ].

All these modalities share the fact that they provide a safe, stable and permanent place to enable the person to feel safe, helping people to develop their capacities, have a more independent life, and feel better integrated with their local community [ 81 ]. All these modalities are based on cohousing between patients in a collective or individual manner, supported and supervised by professionals [ 80 , 81 ].

Our results highlight another alternative for recovery housing research: the development of cohousing projects for patients with healthy people over short time periods. Cohousing experiences and direct exchanges between psychiatric patients and adolescents, may be a therapeutic alternative for promoting mental health, preventing mental illness, reducing addiction to substances, and, even, discrimination, while increasing confidence and helping individuals with schizophrenia in their decision making. These results may be used to develop cohousing programs in controlled environments.

These experiences can also include other types of residents co-residents such as healthcare and social workers, even family members of the patients themselves. We would like to thank Julio Vielva for his support and all the participants who contributed to this study. We are especially grateful to the Hospitaller Order of Saint John of God, and the people who suffer mental disorders, as well as the participating students.

Thank you for your courage. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background A number of programs have been developed to promote the contact between adolescents and mentally-ill patients, in order to break the stigma, improve understanding, promote mental health and prevent substance abuse. Methods A qualitative case-study approach was implemented. Results The themes identified included a learning to live together: students and patients participate and learn together; b the perception of the illness and the mentally-ill: the barrier between health and disease is very slim, and society tends to avoid contact with those who are ill; c change: a transformation takes place in students, in their self-perception, based on the real and intense nature of the experience; d a trial and an opportunity: patients test their ability to live outside the hospital; e discharge and readmission: discharge is experienced as both a liberation and a difficulty, whereas relapse and readmission are experienced as failures.

Conclusions Our findings can help us to better understand schizophrenia and encourage a more positive approach towards both the illness and those who suffer from it. Introduction Schizophrenia is a psychiatric disorder characterized by delusions and hallucinations positive symptoms , accompanied by impaired motivation, social withdrawal negative symptoms , and cognitive impairment [ 1 , 2 ]. Materials and methods Qualitative methods are useful for understanding the beliefs, values, and motivations that underlie individual health behaviors [ 37 , 38 ].

Study design A qualitative descriptive case study with embedded units was conducted [ 37 , 44 , 45 , 46 ]. Participants We included participants who constituted units of analysis and who could provide information regarding the phenomenon under study S1 Fig. Inclusion criteria.

Participants in the cohousing experience: patients and students. Patients diagnosed with schizophrenia by their psychiatrist, classified according to the ICD F Sampling strategies A purposeful sampling strategy was employed [ 46 , 49 ], which involved deliberately selecting participants. Download: PPT. Data collection Data were acquired over a period spanning seven months to one year, from September until March Non-participant observation.

Focus groups. Written documents. Data analysis A thematic, inductive analysis was performed [ 46 , 53 ]. Results Fifty-one participants were included in the study. Theme 1. Theme 2. The perception of the illness and of the mentally ill The students described a change in the way they view those who are ill. Theme 3. Change Students remarked that a change and a transformation had taken place within them.

Theme 4. A test and an opportunity The cohousing experience was perceived as both a test and an opportunity for patients. Theme 5. Discharge and readmission Cohousing represents a step closer towards being discharged. Discussion The most relevant results of this study include: students and patients participating and learning together; a slim barrier between health and disease, a transformation taking place in students, regarding their self-perception, patients testing their ability to live outside the hospital, and discharge, experienced as both a liberation and a difficulty, whereas relapse and readmission are experienced as a failure.

Conclusions Our findings can help us to better understand the relationships and perceptions between people with mental illness and those without. Supporting information.

Risk and Protective Factors in Schizophrenia

S1 File. S2 File. Permission to use photos of Respaldiza House. Hospitaller Order of Saint John of God. S3 File. Procedure for the cohousing initiative. S4 File. Focus group: Question guide for patients with schizophrenia. English version. S5 File. Spanish version. S6 File. Focus group: Question guide for participants. S7 File. S8 File. S9 File. S10 File. S11 File. Ethical considerations for students and schizophrenia patients. S1 Photo. Respaldiza House photos. S1 Fig. Case-study components. Acknowledgments We would like to thank Julio Vielva for his support and all the participants who contributed to this study.

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