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Open Access Research article

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

Emily Eisner1*, Christine Barrowclough1, Fiona Lobban2 and Richard Drake3

Author Affiliations

1 Clinical Psychology Department, Zochonis Building (2nd Floor), University of Manchester, Oxford Road, Manchester M13 9PL, UK

2 Division of Health Research, Spectrum Centre for Mental Health Research, Furness building, University of Lancaster, Lancaster LA1 4YW, UK

3 Institute of Brain Behaviour and Mental Health, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK

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BMC Psychiatry 2014, 14:201  doi:10.1186/1471-244X-14-201

Published: 16 July 2014

Abstract

Background

Early 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.

Methods

Data 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.

Results

Three 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).

Conclusions

There 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.

Keywords:
Relapse; Psychosis; Schizophrenia; Early signs; Basic symptoms; Prodrome; Intervention; Qualitative