Mark Pierson, Katie Nugent, Ph.D., Jaimie Toroney, Ashley Fenton, Amy Lee, Mansi Mehta, William Eaton, Ph.D.

Monitoring recovery: A relation between symptoms, stigma, and maladaptive functioning for people recovering from psychotic disorders

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Stigma – a negative reaction toward a group or individual because of a perceived inferiority – is associated with more severe psychotic symptomology (Ertugrul & Ulug, 2004) and is a significant barrier to recovery for people living with psychotic disorders (Kleim et al., 2008).

The purpose of the present study is to explore the relations between recovery from severe mental illness (SMI), maladaptive functioning, posiitve and negative symptom severity, and stigma. Persons diagnosed with severe psychopathology have varying trajectories of recovery after diagnosis. The correlation between recovery and the reduction of psychotic symptomology is poorly understood.

The Institutional Review Board (IRB) at the Johns Hopkins University Bloomberg School of Public Health approved the present study and every participant provided informed consent. We recruited 266 participants who were diagnosed with Schizophrenia (39%) or Bipolar (61%) Disorders I or II, were fluent in English, were at least 15 years of age, were able to complete a brief cognitive test of understanding, and were residents of Baltimore city or county in the Maryland area. Our nearly gender balanced sample (Men, 53.4%; Women, 46.6%) was diverse, however, a large proportion of participants were African American (54.1%), adults (Years of Age: M = 42, SD = 11), attended high school (Years of education: M = 12, SD = 2), and were from a low socio-economic background (Household income < $10,000 = 58%). Participants were followed up to three years and received an $80 incentive upon completion of yearly follow – up visits and $50 for baseline visits. Participants were given an additional $20 if they donated a blood sample for baseline and follow – up visits.

To measure maladaptive functioning we used the Behavior and Symptom Identification Scale (BASIS 24; Cameron et al., 2007). We measured clinical symptoms with the Positive and Negative Syndrome Scale (PANSS; Kay, Flszbein, & Opfer, 1987). Stigma was measured with the Internalized Stigma for Mental Illness scale (ISMI; Ritsher, Otilingam, & Grajales, 2003) and recovery was measured with the Recovery Assessment Scale (RAS; Corrigan, Salzer, Ralph, Sangster, & Keck, 2004).

We conducted a multiple-linear regression analysis with our cross-sectional baseline data. After accounting for demographic variables we found the scores from overall maladaptive functioning, positive and negative symptoms, and stigma accounted for 34% of the variance in recovery, Adj. R² = .34, F(11, 254) = 8.3, p < .001. These findings emphasize a strong relation between recovery, stigma, maladaptive functioning, and psychotic symptoms in our SMI sample. If clinicians can attempt to remove the barriers of stigma and attenuate psychotic symptoms, maladaptive functionality may decrease, bolstering recovery of SMI populations. Perhaps patients recovering from psychotic disorders could benefit from focusing on coping with stigma in therapy and, which consequently might reduce symptom load and proliferate recovery.