Clinical and cognitive correlates of perceived extent of recovery in Chinese patients with psychosis

Abstract

BACKGROUND: Recovery from psychotic disorders is a multi-dimensional concept. Clinical definition of recovery usually comprises symptomatic remission and adequate functioning. However, a local qualitative study confirmed that cessation of medication is one of the necessary conditions of recovery as perceived by patients. This cross-sectional study aimed to explore whether perceived extent of recovery was related to clinical symptoms (positive, negative, and depressive) and executive function. METHODS: Patients were asked to assess their perceived extent of recovery after 6 months of psychiatric treatment by a visual analogue scale based on the Psychosis Recovery Inventory developed by Chen and his colleagues (2005). The subjective ratings were later converted into scores ranging from 0 to 100 (full recovery) and compared with the operationally defined remission and recovery by t-tests. The definition of remission was operationally defined by Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms. Recovery was defined as remission plus an additional criterion of adequate functioning as measured by Social and Occupational Functioning Assessment Scale. Multiple linear regression was used to correlate the subjective ratings with symptoms, and executive function as measured by Modified Wisconsin Card Sorting Test (MWCST), semantic verbal fluency (animals) and trail making task. RESULTS: This study had assessed 78 Chinese patients with psychotic disorders in Hong Kong. 47 (60.3%) of them were male. The median duration of untreated psychosis was 121 days. The median (inter-quartile range) and mean (s.d.) scores of perceived recovery were 80 (26.3) and 73.4 (21.6) respectively. 42 (53.8%) patients perceived at least 80% recovery while 9 (11.5%) perceived full recovery. Clinically, 62 (79.5%) and 30 (38.5%) patients were categorized as in remission and recovery. Patients who had achieved remission or recovery had no difference in their perceived recovery from patients who did not (P = 0.12 and P = 0.28, respectively). The multiple linear regression showed that patients perceived greater recovery had fewer perseverative errors in MWCST (adjusted R2 = 0.095, P = 0.004). Perceived recovery was not significantly correlated with positive, negative and depressive symptoms. DISCUSSION: Patients who had clinically assessed to be in remission or recovery did not perceive higher level of recovery, suggesting that patients may be using different evaluation criteria. Executive dysfunction was related to subjective perception of recovery but the variances explained (R2) were small. More research is required to explore factors associating with perceived recovery.