UP'S
A longitudinal cohort study into what makes people with psychiatric problems happier.

Recovery and rates of remission have been found to vary considerably among
psychotic disorder patients. Although the majority of patients reaches
symptomatic remission within the first year after a first episode of
schizophrenia (Zipursky, Reilly, & Murray, 2013), the percentage of patients
found to fully recover of schizophrenia and/or other psychosis over time was
only about 14%. Since the exact population prevalences of psychotic disorders
are unknown, the percentage of total psychotic patients in recovery is probably
even lower (Delespaul, 2013). Therefore, it is believed necessary to observe
the forms of recovery over a longer period of time to identify determinants,
protective aspects and interventions contributing to reaching recovery.

The aim of this study is to investigate how many patients with an early and/or
chronic psychotic disorder reach personal recovery during follow-up and which
determinants and processes influence personal, clinical, functional and
societal recovery over time. As determinants we measure somatic functioning,
sleep, diagnosis, medication, treatment, adverse childhood experiences, trauma,
addiction, attachment, cognition, social cognition, coping, illness insight,
empowerment, resilience, internalised stigma, disability in functioning and
therapy adherence. Is recovery a slow and steady process or does it happen more
jolted? Another objective is to test and develop interventions focussing on
enhancing recovery.

A prospective cohort study.

Recovery was long believed to be out of reach for patients with psychotic
disorders. With a shift towards hope for, and the possibility of recovery
(Deegan, 1993), it is now considered common knowledge that those with a severe
mental illness can recover.
However, lack of consensus on a definition of recovery remains, resulting in
confusion among patients, family members, clinicians, policy makers and
researchers (Noiseux & Ricard, 2008). Furthermore, studies have focussed on
part of the recovery process, depending on their research interest.
What is not known yet, is how the different aspects of one's life are connected
in that process of recovery or whether there is an order in recovery. As long
as the nature/definition of recovery remains ambiguous, full recovery-oriented
services and mental health care cannot be offered (Noiseux et al., 2010). By
identifying determinants and long term processes, this study aims to improve
the knowledge of recovery, in order to support patients in a more complete,
recovery-oriented manner in the future.
There will be a few minor burdens for participating in this study. Since the
aim is to identify determinants and processes within al main aspects of life
(clinical, functional, personal, societal), the amount of time each participant
spends answering questions might be experienced as extensive. There are
questionnaires which can be experienced as intrusive or burdensome. Clinical
measures, cognitive tests, personal questionnaires and societal measures are
answered and filled out every two years, along with overall recovery measures.
Those overall measures are also collected every year.
All assessments take place either at home or in the mental health care facility
the participant is receiving care. All assessments will be scheduled at times
convenient for the participant.
For validation of one of the parameters, a subgroup of the participants will be
asked to fill in an extra questionnaire. They will also be asked to fill in
four questionnaires again two weeks after the first assessment.
Furthermore, 60 students are asked to fill in these four questionnaires once.