Persons diagnosed with severe psychopathology have varying trajectories after diagnosis. Some return to their premorbid level of functioning after one episode of illness. Others learn how to manage their symptoms, and while these symptoms are still present, are able to function and live a meaningful life. Still others remain disabled due to their illness. The correlates of these trajectories and outcomes are poorly understood. In part as a result of a growing consumer movement, the field of psychiatric treatment has recently moved in the direction of promoting a broadly defined concept of recovery which encompasses multiple areas of functioning and well-being, as opposed to a narrow treatment focus only on reducing symptoms and preventing relapse. The 2003 President’s New Freedom Commission on Mental Health reported that “care must focus on increasing consumers’ ability to successfully cope with life’s challenges, on facilitating recovery, and on building resilience, not just on managing symptoms. . . . For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability. For others, recovery implies the reduction or complete remission of symptoms.” The purpose of this study is to monitor the experience of recovery from severe mental illness, searching for predictors of good recovery by interviewing participants to asses their current mental health state, functioning, and life experiences, and by performing genetic testing.
We plan on enrolling 1,000 adults that are current patients at The Johns Hopkins Hospital or the Johns Hopkins Bayview Medical Center. Eligible individuals have a current diagnosis of a mental illness that includes psychotic symptoms or a current diagnosis of Bipolar Disorder. There will be substantial overlap with the Access to Wellness cohort and together the two groups will be the “BMORE cohort.” We will meet with participants annually for five years to assess their process of recovery. We have embraced the multidimensional view of recovery after experiencing an episode of severe mental illness, and have designed an instrument that assesses the following domains: psychiatric symptoms; independent living and functioning; recreational activities; social contact and support; family interactions; work, school, or volunteer participation; substance use; criminal involvement; optimism and hope towards the future; knowledge of one’s own mental illness; ability to manage one’s symptoms; knowledge of mental health services. By assessing these components of recovery, we will be able to document the experience of recovery, as well as search for correlates of recovery. We will also be able to use this instrument in combination with the pharmacogenomic component of our study, such that this instrument will provide the basis for determining outcome in association with medications.
This research is sponsored by an anonymous donation to the Center for Mental Health Initiatives.
Primary Investigator: William Eaton, Ph.D.
Co-Investigators: Peter Zandi, Ph.D., Anita Everett, M.D., Bernadette Cullen, M.D., and Katie Bonebrake, M.A.