title: Predicting engagement with services for psychosis: insight, symptoms and recovery style.
abstract: BACKGROUND
  Treatment non-adherence and service disengagement are commonly attributed to impaired insight. There is evidence that recovery style (i.e. psychological adjustment) may underlie service engagement.
  
  
  OBJECTIVE
  We examined whether insight, psychotic symptoms or individuals' recovery style ('integration' v. 'sealing-over') predicts service engagement.
  
  
  METHODS
  Fifty patients with schizophrenia were assessed during acute psychosis and at 3-month and 6-month follow-ups. Measures included recovery style, psychosis symptoms, insight and service engagement.
  
  
  RESULTS
  Sealing-over at 3 months following onset of an episode of psychosis predicted low service engagement at 6 months. Neither insight nor symptoms predicted engagement. The clear shift from integration to sealing-over within the first 3 months was independent of changes in symptoms or insight. Sealing-over between 3 and 6 months was associated with improvement in psychosis symptoms.
  
  
  CONCLUSIONS
  Recovery style contributed more to engagement than did insight, appears to be dynamic in the short term and is orthogonal to insight. Overall, this study demonstrated the importance of addressing psychological adjustment to psychosis as well as illness status when investigating treatment engagement in people with psychosis.
authors.affiliation: School of Psychology, University of Birmingham, UK. lat726@bham.ac.uk
authors.forename: Lynda
authors.initials: L
authors.lastname: Tait
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
authors.forename: Peter
authors.initials: P
authors.lastname: Trower
mesh_terms: D000208:Acute Disease; D000223:Adaptation, Psychological; D000328:Adult; D001364:Awareness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012803:Sick Role; D016896:Treatment Outcome