Early intervention in psychosis for first episode psychotic mania: the experience of people diagnosed with bipolar disorder.

BACKGROUND: Early intervention for people diagnosed with bipolar disorder has been identified as a priority, but little is known about how existing early intervention services are experienced by this group or could be tailored to their needs. AIMS: This study examined the experience of early intervention in psychosis (EIP) services for people diagnosed with bipolar disorder, following first episode psychotic mania. METHOD: Semi-structured interviews were conducted with 11 adults in EIP services and analysed using Interpretative Phenomenological Analysis. RESULTS: One superordinate theme was formed, Rebuilding within EIP service, consisting of five subthemes: (i) Piecing together episode through talking to staff; (ii) Exploring other perspectives during CBT; (iii) Empowered through shared decision-making; (iv) Reconsidering future and purpose; (v) Service as safety-net. EIP provision was pivotal in helping participants understand their episode, adjust their perspective, build confidence and progress. CONCLUSIONS: Aspects of the service that were valued, including person-centred relationships with staff, shared decision-making and the development of motivation and opportunities, reflect key principles of mental health care for young people following first episode psychosis. Furthermore, findings point to elements that may be particularly relevant to early intervention following first episode psychotic mania including managing mood escalation and individualised approaches to goals.

Recovering from first episode psychotic mania: The experience of people diagnosed with bipolar disorder.

AIM: Early intervention for people diagnosed with bipolar disorder is a priority, but little is known about how recovery from first episode psychotic mania is experienced by this group. This study aimed to explore the experience of recovery from first episode psychotic mania for people diagnosed with bipolar disorder. METHODS: Semi-structured interviews were conducted with 11 young adults during recovery from first episode psychotic mania and were analysed using Interpretative Phenomenological Analysis. RESULTS: Three themes were identified: (i) 'Possession of purpose and staying well', (ii) 'Coping with compromise' and (iii) 'Manic relapse: pressure and proving self'. On becoming well, the participants experienced a sense of purpose through engaging with activities and goals that also drove their efforts to engage in strategies to stay well. However, these strategies created feelings of compromise that not all were prepared to accept. Though having purpose and goals created a positive sense of direction, for a minority of the participants they also created additional pressure, contributing to manic relapse. CONCLUSIONS: The purpose created by engaging with aspirations and career-related activities during early intervention was found to be important for a meaningful recovery from first episode bipolar disorder. This instilled positivity and purpose, motivating efforts to maintain wellness. The feelings of compromise that some participants experienced point to the need for individually tailored interventions. Findings suggest a delicate relationship between the positivity of engaging in goals and the risk of manic relapse during recovery from first episode psychotic mania.

Being depleted and being shaken: An interpretative phenomenological analysis of the experiential features of a first episode of depression.

OBJECTIVES: This article presents a detailed idiographic analysis of patients' experience of first-episode depression. DESIGN: This is a qualitative interview study using interpretative phenomenological analysis (IPA). METHODS: Semi-structured interviews were carried out with a purposive sample of seven patients presenting to a mental health service in London, UK with symptoms of first-episode major depression. There were four males and three females; mean age was 44 years. Interviews were audio-recorded and subjected to IPA. RESULTS: Participants described a significant loss event prior to onset of depression. The depression involved a major diminishing of the life-world with relational, corporeal, and temporal depletion. This depletion was accompanied in each case by occasional extreme emotions, frenzied thoughts, confused sense of self. CONCLUSIONS: Depression can represent a major existential threat to the sufferer. We discuss how our findings can illuminate the extant literature. The study suggests the value of exploring these existential features in early therapy. PRACTITIONER POINTS: Offers a detailed phenomenological analysis of core experiential features of first episode depression: being alone, being empty, life is over. Also reveals an unstable dynamic of major psychological depletion interrupted by emotional and cognitive agitation involving confusion, lack of confidence, and/or trust. Provides rationale and material for intensive exploration of these features in therapy.