• Objectivity in psychoanalytic assessment of couple relationships

      Evans, Chris (2003)
      Background: Clinicians claim that partners in a couple can be understood to share a mode of relating, at an unconscious level. Assessment of this depends on inference from observable data. This study tests the viability and reliability of a modification of the Personal Relatedness Profile (PRP) for this purpose. Aims: To test the interrater reliability and construct validity of a joint PRP score for couples. Method: Seven therapists independently rated couples' interactions using the 30-item PRP and segments of videotaped interviews with 19 couples. Results: Interrater reliability was good and correlations between items clearly supported the underlying Kleinian bipolar model used (paranoid-schizoid/depressive positions). Conclusions: Psychoanalytic couple psychotherapists agree in independent judgements of the nature of couple functioning, these judgements being based on envisaging couples in terms of an unconsciously shared state of mind.
    • Oestrogen (adjunct) versus placebo for women with schizophrenia

      Grigorov, Hristo S. (2016)
      This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the clinical efficacy and safety of oestrogen as an adjunctive treatment versus placebo, in women with schizophrenia or schizophrenia-like illnesses. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
    • Olanzapine discontinuation for schizophrenia

      Adams, Clive E. (2012)
      This is the protocol for a review and there is no abstract. The objectives are as follows: To investigate the effects of discontinuing olanzapine in people with schizophrenia.
    • Olanzapine for schizophrenia

      Rathbone, John (2005)
      Background: Olanzapine is an atypical antipsychotic reported to be effective without producing disabling extrapyramidal adverse effects associated with older, typical antipsychotic drugs. Objectives: To determine the clinical effects and safety of olanzapine compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and schizophreniform psychoses. Search strategy: We updated the first search [Biological Abstracts (1980-1999), The Cochrane Library (Issue 2, 1999), EMBASE (1980-1999), MEDLINE (1966-1999), PsycLIT (1974-1999) and The Cochrane Schizophrenia Group's Register (October 2000)] in October 2004 using theCochrane Schizophrenia'sGroup's register of trials.We also searched references of all included studies for further trials, and contacted relevant pharmaceutical companies and authors. Selection criteria: We included all randomised clinical trials comparing olanzapine with placebo or any antipsychotic treatment for peoplewith schizophrenia or schizophreniform psychoses. Data collection and analysis: We independently extracted data and, for homogeneous dichotomous data, calculated the random effects relative risk (RR), the 95% confidence intervals (CI) and the number needed to treat (NNT) on an intention-to-treat basis. For continuous data we calculated weighted mean differences. Main results: Fifty five trials are included (total n>10000 people with schizophrenia). Attrition from olanzapine versus placebo studies was >50% by six weeks, leaving interpretation of results problematic. Olanzapine appeared superior to placebo at six weeks for the outcome of 'no important clinical response' (any dose, 2 RCTs n=418, RR 0.88 CI 0.8 to 0.1, NNT 8 CI 5 to 27). Although dizziness and dry mouth were reported more frequently in the olanzapine-treated group, this did not reach statistical significance. The olanzapine group gained more weight. When compared with typical antipsychotic drugs, data from several small trials are incomplete.With high attrition in both groups (14 RCTs, n=3344, 38%attrition by six weeks, RR 0.81 CI 0.65 to 1.02) the assumptions included in all data are considerable. For the short term outcome of 'no important clinical response', olanzapine seems as effective as typical antipsychotics (4 RCTs, n=2778, RR 0.90 CI 0.76 to 1.06). People allocated olanzapine experienced fewer extrapyramidal adverse effects than those given typical antipsychotics. Weight change data for the short term are not statistically significant but results between three to 12 months suggest a clinically important average gain of four kilograms for people given olanzapine (4 RCTs, n=186, WMD 4.62, CI 0.6 to 8.64). Twenty three percent of people in trials of olanzapine and other atypical drugs left by eight weeks; 48%by three to12 months (11 RCTs, n=1847, RR 0.91 CI 0.82 to 1.00). There is little to choose between the atypicals, although olanzapine may cause fewer extrapyramidal adverse effects than other drugs in this category. Olanzapine produces more weight gain than other atypicals with some differences reaching conventional levels of statistical significance (1 RCT, n=980, RR gain at 2 years 1.73 CI 1.49 to 2.00, NNH 5 CI 4 to 7). There are very few data for people with first episode illness (1 RCT, duration 6 weeks, n=42). For people with treatment-resistant illness there were no clear differences between olanzapine and clozapine (4 RCTs, n=457). Authors' conclusions: The large proportion of participants leaving studies early in these trials makes it difficult to draw firm conclusions on olanzapine's clinical effects. For people with schizophrenia it may offer antipsychotic efficacy with fewer extrapyramidal adverse effects than typical drugs, but more weight gain. There is a need for further large, long-term randomised trials with more comprehensive data. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
    • Open Dialogue for psychosis or severe mental illness

      Pavlovic, Ruth Y. (2016)
      This is the protocol for a review and there is no abstract. The objectives are as follows: To systematically evaluate the effects of the Open Dialogue approach for people with psychosis or severe mental illness. © 2016 The Cochrane Collaboration.
    • Open general medical wards versus specialist psychiatric units for acute psychoses

      Rathbone, John (2007)
      Background: As international healthcare policy has moved away from treating people with severe mental illness in large inpatient psychiatric institutions, beds for people with acute psychiatric disorders are being established in specialised psychiatric units in general hospitals. In developing countries, however, limited resources mean that it is not always possible to provide discrete psychiatric units, either in general hospitals or in the community. An alternative model of admission, used in the Caribbean, is to treat the person with acute psychosis in a general hospital ward. Objectives: To compare the outcomes for people with acute psychosis who have been admitted to open medical wards with those admitted to conventional psychiatric units. Search strategy: We searched The Cochrane Schizophrenia Group's study-based register (April 2007). This register is compiled from searches of BIOSIS, CINAHL, The Cochrane Library, EMBASE, LILACS, MEDLINE, PsycINFO, PSYNDEX, Sociofile, and many conference proceedings. Selection criteria: We would have included all relevant randomised or quasi-randomised trials, allocating anyone thought to be suffering from an acute psychotic episode to either acute management on general medical wards, or acute management in a specialist psychiatric unit. The primary outcomes of interest were length of stay in hospital and relapse. Data collection and analysis: We extracted data independently. For dichotomous data we would have calculated relative risks (RR) and their 95%confidence intervals (CI) on an intention-to-treat basis based using a fixed effects model. Main results: We didnt identify any relevant randomised trials. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
    • "Opening the curtains": How do voice hearers make sense of their voices?

      Tickle, Anna C. (2015)
      OBJECTIVE: The current study sought to explore how, if at all, people construct an understanding of the origin and maintenance of their experience of hearing voices.METHOD: A social constructionist grounded theory method was adopted throughout the research process. Eight voice hearers, who were distressed by this experience, were recruited and interviewed.RESULTS: Three overarching descriptive categories were constructed regarding participants' understanding of the development and maintenance of hearing voices; search for meaning, view of self, and framework for understanding voices. The "essence" of the developing grounded theory was that individuals actively searched for meaning of their voices through different frameworks, but the relative "success" of this pursuit, and potential usefulness of an understanding, is influenced by the individual's perceptions of agency, stigma, and hope(lessness).CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This research illustrates how voice hearers actively searched for meaning in relation to their voices and the challenges they encountered during this process. One clinical implication from this study emphasizes the potential role of psychological formulation in generating a shared understanding of the voices. Future research is warranted to explore voice hearers from a wider range of cultural, religious, and spiritual backgrounds.<br/>Copyright (c) 2015 APA, all rights reserved).
    • Oral health advice for people with serious mental illness

      Tosh, Graeme; Wells, Nicola (2011)
      The objective of this review is to find the effects of oral health advice for people with serious mental illness. We searched the Cochrane Schizophrenia Group Trials Register (October 2009), inspected references of all identified studies, and contacted the first author of each included study if required. We independently extracted data and calculated random effects, relative risk, 95% CI, and, where appropriate, numbers needed to treat/harm on an intention-to-treat basis. For continuous data, we calculated weighted mean differences. Result shows that one randomized controlled trial, randomizing fewer than 60 people to receive oral health motivational interviewing from a psychologist in addition to an education package vs the use of the education package alone. After 8 weeks, the intervention group showed a better dental state and a higher level of knowledge about oral health. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Oral medication for agitation of psychiatric origin: A scoping review of randomized controlled trials

      Shokraneh, Farhad; Adams, Clive E. (2017)
      Background: Understanding more about the efficacy and safety of oral second-generation antipsychotic medications in reducing the symptoms of acute agitation could improve the treatment of psychiatric emergencies. Objective: The objective of this scoping review was to examine the evidence base underlying expert consensus panel recommendations for the use of oral second-generation antipsychotics to treat acute agitation in mentally ill patients. Methods: The Cochrane Schizophrenia Group's Study-Based Register was searched for randomized controlled trials comparing oral second-generation antipsychotics, benzodiazepines, or first-generation antipsychotics with or without adjunctive benzodiazepines, irrespective of route of administration of the drug being compared. Six articles were included in the final review. Results: Two oral second-generation antipsychotic medications were studied across the six included trials. While the studies had relatively small sample sizes, oral second-generation antipsychotics were similarly effective to intramuscular first-generation antipsychotics in treating symptoms of acute agitation and had similar side-effect profiles. Conclusions: This scoping review identified six randomized trials investigating the use of oral second-generation antipsychotic medications in the reduction of acute agitation among patients experiencing psychiatric emergencies. Further research will be necessary to make clinical recommendations due to the overall dearth of randomized trials, as well as the small sample sizes of the included studies.<br/>Copyright &#xa9; 2017 Elsevier Inc.
    • Oxidative stress and the pathophysiology and symptom profile of schizophrenia spectrum disorders

      Katshu, Mohammad Z.; Liddle, Peter F. (2021)
      Schizophrenia is associated with increased levels of oxidative stress, as reflected by an increase in the concentrations of damaging reactive species and a reduction in anti-oxidant defences to combat them. Evidence has suggested that whilst not the likely primary cause of schizophrenia, increased oxidative stress may contribute to declining course and poor outcomes associated with schizophrenia. Here we discuss how oxidative stress may be implicated in the aetiology of schizophrenia and examine how current understanding relates associations with symptoms, potentially via lipid peroxidation induced neuronal damage. We argue that oxidative stress may be a good target for future pharmacotherapy in schizophrenia and suggest a multi-step model of illness progression with oxidative stress involved at each stage.
    • Parental loss before the age of 16 years: A comparative study of patients with personality disorder and patients with schizophrenia in a high secure hospital's population

      Pert, Linda; Ferriter, Michael; Saul, Cleopatra (2004)
      There is a considerable body of literature supporting an association between separation from parent in childhood and later personality disorder. This study compares a 10-year cohort of high secure hospital patients who had either a personality disorder or schizophrenia, but with no other significant psychiatric comorbidity. The information source was the Special Hospitals Case Register. The most important finding was a statistically significant difference in the rates of child-parent separation between the two groups. In the personality disorder group, 119/147 (81%) of the patients had been separated from one or both parents before the age of 16 compared to 178/289 (62%) in the schizophrenia group.
    • Peer support for internalised stigma experienced by people with psychosis: Rationale and recommendations

      Machin, Karen (2018)
      People with experience of psychosis face stigma and discrimination, which can be a significant barrier to recovery. Internalisation of public stereotypes and prejudice into an individual’s self-identity is an understandable consequence of such discrimination. However, internalised stigma represents a significant barrier to recovery, resulting in a number of harmful consequences such as depression, demoralisation and loss of self-esteem. Interventions to support people with experience of psychosis who internalise stigma have demonstrated some promising results, but a recent meta-analysis did not find an overall significant effect. The current evidence base includes very few trials of peer support for internalised stigma; however, data from several trials and a recent meta-analysis show that peer support produces benefits on a number of dimensions related to internalised stigma, including empowerment, recovery and hope. In this paper, we argue that peer support is a suitable intervention for addressing internalised stigma and warrants further research. We provide a theoretical and evidence-based rationale for this argument and outlines some of the key challenges and possible solutions for future trials of peer support as an intervention for internalised stigma. © 2018 Informa UK Limited, trading as Taylor & Francis Group
    • Perphenazine for schizophrenia

      Sampson, Stephanie (2015)
      Background: Perphenazine is an old phenothiazine antipsychotic with a potency similar to haloperidol. It has been used for many years and is popular in the northern European countries and Japan. Objectives: To examine the clinical effects and safety of perphenazine for those with schizophrenia and schizophrenia-like psychoses. Search methods: We updated our original search using the Cochrane Schizophrenia Group's register (September 2013), references of all included studies and contacted pharmaceutical companies and authors of included studies in order to identify further trials. Selection criteria: We included all randomised controlled trials that compared perphenazine with other treatments for people with schizophrenia and/or schizophrenia-like psychoses. We excluded trials of depot formulations of perphenazine. Data collection and analysis: Two review authors independently inspected citations and, where possible, abstracts. We ordered papers, inspected and quality assessed them. We extracted data, again working independently. If loss to follow-up was greater than 50% we considered results as 'prone to bias'. For dichotomous data, we calculated risk ratios (RR) and for continuous data we calculated mean differences (MD), both with the 95% confidence intervals (CI). We assessed quality of data using the GRADE (Grading of Recommendations Assessment, Development and Evaluationtool) and assessed risk of bias for included studies. Main results: Thirty-one studies fulfilled the inclusion criteria, with a total of 4662 participants (of which 4522 were receiving the drugs relevant to our comparison) and presented data that could be used for at least one comparison. The trial centres were located in Europe (especially Scandinavia), Japan and Northern America. When comparing perphenazine with placebo, for our primary outcome of clinical response, results favoured perphenazine with significantly more people receiving placebo rated as either 'no better or deterioration' for global state than people receiving perphenazine (1 RCT, n = 61 RR 0.32 CI 0.13 to 0.78, very low quality evidence). More people receiving placebo relapsed, although not a statistically significant number (1 RCT, n = 48, RR 0.14 CI 0.02 to 1.07, very low quality evidence). Death was not reported in the perphenazine versus placebo comparison. Experiences of dystonia were equivocal between groups (1 RCT, n = 48, RR 1.00 CI 0.07 to 15.08, very low quality evidence); other outcomes not reported in this comparison include serious adverse events, economic outcomes, and service use and hospitalisation. For the comparison of perphenazine versus any other antipsychotic drugs, no real differences in effect between the drugs were found. There was no significant difference between groups for those considered 'no better or deterioration' (17 RCTs, n = 1879, RR 1.04 CI 0.91 to 1.17, very low quality evidence). For mental state outcome of 'no effect' of the study drug, there was again no significant difference between groups (4 RCTs, n = 383, RR 1.24 CI 0.61 to 2.52, very low quality evidence). Death was not reported in any of the included studies. There was no significant difference in rates of dystonia with perphenazine versus any other antipsychotic drugs (4 RCTs, n = 416, RR 1.36 CI 0.23 to 8.16, very low quality evidence), nor was there a significant difference between groups for serious adverse events (2 RCTs, n = 1760, RR 0.98 CI 0.68 to 1.41, very low quality evidence). Authors' conclusions: Although perphenazine has been used in randomised trials for more than 50 years, incomplete reporting and the variety of comparators used make it impossible to draw clear conclusions. All data for the main outcomes in this review were of very low quality evidence. At best we can say that perphenazine showed similar effects and adverse events as several of the other antipsychotic drugs. Since perphenazine is a relatively inexpensive and frequently used compound, further trials are justified to clarify the properties of this classical antipsychotic drug.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.
    • Personal recovery in people with a psychotic disorder: A systematic review and meta-analysis of associated factors

      Slade, Mike (2021)
      Background: Personal recovery (PR) is a subjective, multidimensional concept, and quantitative research using PR as an outcome is rapidly increasing. This systematic review is intended to support the design of interventions that contribute to PR in psychotic disorders, by providing an overview of associated factors and their weighted importance to PR: clinical factors, social factors, and socio-demographic characteristics are included, and factors related to the concept of PR (organized into CHIME dimensions). Methods: A systematic literature search was conducted from inception to March 2020. Quantitative studies that had used a validated questionnaire assessing the concept of PR were included. Mean effect sizes for the relationship between PR-scale total scores and related factors were calculated using meta-analyses. Sources of heterogeneity were examined using meta-regression tests. Results: Forty-six studies, that used (a total of) eight PR measures, showed that in clinical factors, affective symptoms had a medium negative association with PR-scale total scores (r = −0.44, 95%CI −0.50 to −0.37), while positive, negative and general symptoms had small negative correlations. No association was found with neuro-cognition. Social factors (support, work and housing, and functioning) showed small positive correlations. Gender and age differences had barely been researched. Large associations were found for PR-scale total scores with the CHIME dimensions hope (r = 0.56, 95%CI 0.48–0.63), meaning in life (r = 0.48, 95%CI 0.38–0.58) and empowerment (r = 0.53, 95%CI 0.42–0.63); while medium associations were found with connectedness (r = 0.34, 95%CI 0.43–0.65) and identity (r = 0.43, 95%CI 0.35–0.50). Levels of heterogeneity were high, sources included: the variety of PR measures, variations in sample characteristics, publication bias, variations in outcome measures, and cultural differences. Discussion: Most interventions in mental healthcare aim to reduce symptoms and improve functioning. With regard to stimulating PR, these interventions may benefit from also focusing on enhancing hope, empowerment, and meaning in life. The strength of these findings is limited by the challenges of comparing separate CHIME dimensions with questionnaires assessing the concept of PR, and by the high levels of heterogeneity observed. Future research should focus on the interaction between elements of PR and clinical and social factors over time. © Copyright © 2021 Leendertse, Wierdsma, van den Berg, Ruissen, Slade, Castelein and Mulder.
    • Physical health care monitoring for people with serious mental illness

      Mala, Shereen; Bachner, Mick (2010)
      Background Current guidance suggests that we should monitor the physical health of people with serious mental illness and there has been a significant financial investment over recent years to provide this. Objectives To assess the effectiveness of physical health monitoring as a means of reducing morbidity, mortality and reduction in quality of life in people with serious mental illness. Search strategy We searched the Cochrane Schizophrenia Group Trials Register (October 2009) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. Selection criteria All randomised or quasi-randomised clinical trials focusing on physical health monitoring versus standard care or comparing i) self monitoring vs monitoring by health care professional; ii) simple vs complex monitoring; iii) specific vs non-specific checks iv) once only vs regular checks or v) comparison of different guidance. Data collection and analysis The authors (GT, AC, SM) independently screened search results and identified three studies as possibly fulfilling the review's criteria. On examination, however, all three were subsequently excluded. Main results We did not identify any randomised trials which assessed the effectiveness of physical health monitoring in people with serious mental illness. Authors' conclusions There is no evidence from randomised trials to support current guidance and practice. Guidance and practice are based on expert consensus, clinical experience and good intentions rather than high quality evidence.
    • Physical restraints versus seclusion room for management of people with acute aggression or agitation due to psychotic illness (TREC-SAVE): A randomized trial

      Adams, Clive E. (2012)
      BACKGROUND: After de-escalation techniques have failed, restraints, seclusion and/or rapid tranquillization may be used for people whose aggression is due to psychosis. Most coercive acts of health care have not been evaluated in trials.
    • Pimozide for schizophrenia or related psychoses

      Rathbone, John (2007)
      Background: Pimozide, formulated in the 1960s, continues to be marketed for the care of people with schizophrenia or related psychoses such as delusional disorder. It has been associated with cardiotoxicity and sudden unexplained deaths. Electrocardiogram monitoring is now required before and during use. Objectives: To assess the clinical effects of pimozide for people with schizophrenia, non-affective psychotic mental illness and delusional disorder. Search strategy: We searched the Cochrane Schizophrenia Group's Register (July 2005). Selection criteria: We sought all relevant randomised clinical trials comparing pimozide with other treatments. Data collection and analysis: Working independently, we inspected citations, ordered papers, and then re-inspected and quality assessed the studies and extracted data. For homogeneous dichotomous data, we calculated the relative risk (RR), 95% confidence interval (CI), and, where appropriate, the number needed to treat (NNT) and the number needed to harm (NNH), on an intention-to-treat basis. We calculated weighted mean differences (WMD) for continuous data. We excluded data if loss to follow-up was greater than 50%. Main results: We found 35 relevant studies (total n=1348), all including people with schizophrenia but none with delusional disorder. 123 people were randomised to pimozide versus placebo. Data suggest that pimozide prevents relapse (2 RCTs, n=66, RR 0.45 CI 0.2 to 0.9, NNT 4 CI 3 to 22). Compared with typical antipsychotic drugs, pimozide has similar efficacy for outcomes of change in global functioning, mental state, relapse and leaving the study early. People allocated to pimozide did not have a higher mortality than those taking other antipsychotic drugs. Pimozide was more likely than typical antipsychotic drugs to cause tremor in the short-term (6 RCTs, n=192, RR 1.6 CI 1.1 to 2.3, NNH 6 CI 3 to 44) and lead to need for antiparkinsonian medication (4 RCTs, n=124, RR 1.8 CI 1.2 to 2.6, NNH 3 CI 2 to 5) than other drugs. In the medium-term, however, pimozide was less likely to cause sedation (5 RCTs, n=231, RR 0.6 CI 0.5 to 0.9, NNH 6 CI 4 to 16). Authors' conclusions: Although there are shortcomings in the data, there is enough overall consistency over different outcomes and time scales to confirm that pimozide is a drug with similar efficacy to other more commonly used antipsychotic drugs such as chlorpromazine for people with schizophrenia. There are no data to support or refute its use for those with delusional disorder. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
    • Positive psychotherapy for psychosis in Hong Kong: A randomized controlled trial

      Slade, Mike (2022)
      Recovery-oriented practice has been advocated in mental health services in Hong Kong since 2009. Well-being has become an important area of focus for mental health services. Positive Psychotherapy for Psychosis (PPP) is a well-being-focused intervention for use in psychosis, with preliminary evidence from a randomized controlled trial in the United Kingdom of impact on well-being and symptomatology. The aim of this study was to test the effectiveness of PPP on the well-being of people with psychosis in Hong Kong. The study was a randomized controlled trial with two-arm parallel groups. Both groups received treatments as usual, and in addition the intervention group received a 13-session intervention based on a Cantonese Chinese translation of the PPP manual. Intention-to-treat analysis was used. The trial was registered (ANZCTR: ACTRN12620000464965). A total of 154 participants (78 intervention, 76 control) were recruited. As compared to control group, intervention group participants showed significant changes over time on the primary outcome of well-being assessed using the Chinese Short Warwick-Edinburgh Mental Well-being Scale (p = 0.001) and on secondary outcomes of hope (Agency subscale: p = 0.029) and self-efficacy (p = 0.001). Positive Psychotherapy for Psychosis was found to be an effective treatment in improving the well-being and other mental health outcomes for people with psychosis. It can be recommended for use in mental health services to promote recovery.
    • Post-traumatic growth in psychosis: a systematic review and narrative synthesis

      Ng, Fiona; Rennick-Egglestone, Stefan; Newby, Christopher; Hare-Duke, Laurie; Llewellyn-Beardsley, Joy; Yeo, Caroline; Slade, Mike (2021)
      BACKGROUND AND OBJECTIVEPeople with psychosis report experiences of highly traumatic events. Positive change or post-traumatic growth (PTG) can occur as a result of traumatic experiences. Yet there is limited attention on PTG in psychosis, possibly due to the negative impact of psychotic symptoms on functioning and quality of life. The aim of this review was to identify significant correlates and mediators of PTG in psychosis, and to develop a conceptual framework synthesising facilitators of PTG in psychosis.METHODTen electronic databases were searched in seven languages, and five journals and grey literature were searched in English. Quantitative studies were eligible if examining correlates, mediators, or the temporal relationship between PTG and one or more variables. Qualitative studies were eligible if describing PTG arising from experiences of psychosis. Findings from quantitative papers were grouped by analysis method, with significant correlates, mediators, and temporal relationships descriptively reported upon. Narrative synthesis was conducted on findings in qualitative papers.RESULTSThirty-seven papers were included. Significant correlates and mediators of PTG were identified. Mediators of PTG in psychosis included meaning in life, coping self-efficacy, core beliefs, and self-reported recovery. No studies describing the temporal relationship between PTG and psychosis were identified. The narrative synthesis identified seven facilitators of PTG in psychosis: Personal identity and strength, Receiving support, Opportunities and possibilities, Strategies for coping, Perspective shift, Emotional experience, and Relationships, giving the acronym PROSPER.CONCLUSIONSIndividuals with psychosis can be supported to grow from traumatic experiences. Clinicians can support PTG through the provision of trauma-informed care that supports positively valued identity changes. For researchers, the findings provide an evidence-based theoretical framework for conceptualising PTG, which can be validated through longitudinal cohort studies and underpin the development of new clinical interventions.