The study advances a conceptual understanding of activity and social participation in the period following the first episode of psychosis.
Method:
A constructivist, grounded theory approach was used. Data were collected from 25 primary participants who had experienced a first episode of psychosis in the previous 5 years; 15 secondary participants, such as family and friends, with knowledge of the activity and social experiences of primary participants, personal records and documents; and six key informants.
Findings:
The first episode of psychosis was highly disruptive and even damaging to activity and social participation. Recovering from this fall-out, to maintain engagement in activities and social participation, included the need to create new plans, adjust to affective disconnection, develop balanced lifestyles, match participation to abilities, learn new skills, and participate under new and constraining social conditions.
Conclusion:
The period following the first episode of psychosis is a time of high risk for disengagement from activity and social participation. Occupational therapists have an important role to play in enabling activity and social engagement. The findings offer examples of how occupational therapy services might address critical tasks for activity and social engagement.
AddingtonJAddingtonD (2004) Psychosocial interventions in early psychosis. In: EhmannTMacEwanGWHonerWG, eds. Best care in early psychosis intervention: Global perspectives. London: Taylor and Francis, 233–40.
2.
AlbistonDJFranceySMHarriganSM (1998) Group programmes for recovery from early psychosis. British Journal of Psychiatry, 172(Suppl.33), 117–21.
3.
BertoloteJMcGorryP (2005) Early intervention and recovery for young people with early psychosis: Consensus statement. British Journal of Psychiatry, 187(Suppl.48), 116–19.
4.
BoydellKMGladstoneBMVolpeT (2003) Interpreting narratives of motivation and schizophrenia: A biopsychosocial understanding. Psychiatric Rehabilitation Journal, 26(4), 422–26.
5.
BrownJA (2001) Talk about life after psychosis: A phenomenological study of the impact of early psychosis on occupational performance. Unpublished Master's thesis. Halifax, NS: Dalhousie University.
6.
CharmazK (2000) Grounded theory: Objectivist and constructivist methods. In: DenzinNKLincolnYS, eds. Handbook of qualitative research. Thousand Oaks, CA: Sage, 509–36.
7.
DeeganP (1996) Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19(3), 91–97.
8.
EdgelowM (2008) Efficacy of an occupational time-use intervention for people with serious mental illness. Unpublished Master's thesis. Kingston, ON: Queen's University.
9.
EklundMLeufstadiusCBejerholmU (2008) Time use among people with psychiatric disabilities: Implications for practice. Psychiatric Rehabilitation Journal, 32(3), 177–91.
10.
FisherASavin-BadenM (2001) The benefits to young people experiencing psychosis and their families of an early intervention programme: Evaluating a service from the consumer's and provider's perspectives. British Journal of Occupational Therapy, 64(2), 58–65.
11.
FraserRBergerGKillackeyEMcGorryP (2006) Emerging psychosis in young people, Part 3 – Key issues for prolonged recovery. Australian Family Physician, 35, 329–33.
12.
HooBNopoulosPFlaumMArndtSAndreasenNC (1998) Two-year outcome in first-episode schizophrenia: Predictive value of symptoms for quality of life. American Journal of Psychiatry, 155, 1196–201.
13.
JonikasJALarisACookJ (2003) The passage to adulthood: Psychiatric rehabilitation service and transition-related needs of young adult women with emotional and psychiatric disorders. Psychiatric Rehabilitation Journal, 27(2), 114–20.
14.
KillackeyEJacksonHGleesonJHickieIMcGorryP (2006) Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first-episode psychosis: Employing cautious optimism. Australian and New Zealand Journal of Psychiatry, 40, 951–62.
15.
KrupaTJacksonJ (2009) A phase-specific approach to occupational recovery in first episode psychosis. Proceedings of the annual conference of the Canadian Association of Occupational Therapists. Ottawa, ON: CAOT Publications.
16.
KrupaTThorntonJ (1986) The pleasure deficit in schizophrenia. Occupational Therapy in Mental Health, 6(2), 65–78.
17.
LawMBaptisteSCarswellAMcCollMAPolatajkoHPollockN (1998) Canadian Occupational Performance Measure (COPM). 3rd ed.Ottawa, ON: CAOT Publications.
18.
LloydCKingR (2007) Early intervention, relapse prevention and promotion of healthy lifestyles. In: KingRLloydCMeehanT, eds. Handbook of psychosocial rehabilitation. Oxford: Blackwell Publishing.
19.
LloydCBassettJSamraP (2000) Rehabilitation programmes for early psychosis. British Journal of Occupational Therapy, 63(2), 76–82.
20.
McGorryPYungA (2003) Early intervention in psychosis: An overdue reform. Australian and New Zealand Journal of Psychiatry, 37, 393–98.
21.
NandlalJKrupaTOyewumiKLawsonJArchieSConradG (2008) Socio-economic disability in first episode psychosis: Patterns and predictors of application for disability income support in four Canadian early intervention programs. Early Intervention in Psychiatry, 2(Suppl.1), A66.
22.
ParlatoLLloydCBassettJ (1999) Young occupations unlimited: An early intervention programme for young people with psychosis. British Journal of Occupational Therapy, 62(3), 113–16.
23.
RosenA (2006) Destigmitizing day-to-day practices: What developed countries can learn from developing countries. World Psychiatry, 5(1), 21–24.
24.
SaleebeyD (1996) The strengths perspective in social work practice: Extension and cautions. Social Work, 41(1), 296–395.
25.
SpencerEBirchwoodMMcGovernD (2001) Management of first-episode psychosis. Advances in Psychiatric Treatment, 7, 133–42.
26.
StraussA (1986) Qualitative research for social scientists. Cambridge: Cambridge University Press.
27.
StraussJSHafezHLibermanPHardingC (1985) The course of psychiatric disorder III: Longitudinal principles. American Journal of Psychiatry, 142(3), 289–96.
28.
TsangHLamPNgBLeungO (2000) Predictors of employment outcome for people with psychiatric disabilities: A review of the literature since the mid-'80s. Journal of Rehabilitation, 66, 19–31.
29.
WoodsideHSchellLAllison-HedgesT (2006) Listening for recovery: The vocational success of people living with mental illness. Canadian Journal of Occupational Therapy, 73(1), 36–43.
30.
WoodsideHKrupaTPocockK (2007) Early psychosis, activity performance and social participation: A conceptual model to guide rehabilitation and recovery. Psychiatric Rehabilitation Journal, 32(2), 125–30.
31.
WoodsideHKrupaTPocockK (2008) How people negotiate for success as psychosis emerges. Early Intervention in Psychiatry, 2, 50–54.
32.
YipK (2005) A strengths perspective in working with an adolescent with depression. Psychiatric Rehabilitation Journal, 28(4), 362–69.
33.
ZafranHTallantBGelinasI (2008) Exploring academic reintegration in early psychosis. Early Intervention in Psychiatry, 2(Suppl.1), A109.
