Department of Sport, Health Sciences and Social Work

Recovery and First Episode Psychosis: A Critical Literature Review

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  • Introduction:

    Over a lifetime, approximately one in 100 people are affected by serious psychosis or schizophrenia at some point in their life (TSC 2012). First episode psychosis (FEP) commonly occurs in late adolescence or early adulthood. Adolescence and young adulthood is a vital phase for social development, vocational accomplishment and establishment of peer networks. Experiencing FEP during this time can therefore significantly impact upon an individual’s educational, vocational, social and emotional development.

    Evidence has shown that intervening within 3-5 years of a FEP can significantly improve long term outcomes. Occupational therapy (OT) is one of the core healthcare professions delivering evidence-based interventions within modern community mental health services, including Early Intervention in Psychosis (EIP) teams. OTs in EIP play a key role in supporting individuals to achieve occupational and functional recovery following a FEP. Despite considerable growth in evidence-based interventions, services and research for young people with FEP, less attention has been given to factors influencing recovery from individuals who have experienced FEP.


    To understand what factors enhance or impede recovery following FEP, from the perspective of those with lived experience. Exploring individuals’ perspectives is fundamental for informing recovery orientated occupational therapy practice.


    This study employed a critical literature review methodology. Four databases were searched systematically from November 2015 until March 2016. Ten qualitative articles meeting the inclusion criteria were retrieved. Methodological quality of these studies was assessed by systematic critical appraisal. The findings of the included studies were thematically analysed.


    Thematic analysis identified a multi-faceted and dynamic relationship between factors enhancing and impeding recovery from FEP. Six key themes were identified. Factors which enhanced recovery included: (1) meaningful occupation, (2) social support, and (3) personal responsibility. The factors that impeded recovery included: (1) stigma, (2) psychological distress, and (3) medication side effects.


    The findings of this review suggest that engagement in meaningful occupations is a core dimension of recovery from FEP. The present study, produced distinctive findings that identified the need for OTs to support individuals to achieve a balance between enhancing and impeding factors. OTs need to maintain an emphasis on the enhancing factors, ensuring ascendance over impeding aspects, in order to facilitate recovery from FEP.