Psych Vivas · General adult psychiatry — psychosis rehabilitation
Psychosocial rehabilitation in psychosis — structured clinical viva
Fellowship viva on psychosocial rehabilitation in psychosis: CHIME, PORT packages, IPS, family PE, RAISE, Slade abuses.
On this page & tools
Target exams
Interpretation
Reveal interpretation
Why not working if voices better? Explain clinical versus functional recovery: cognition, negatives, skills, confidence, stigma and opportunity barriers continue after positive-symptom improvement. Medication is necessary but not sufficient.[1][5]
Keep him home until 100% cured? Prolonged enforced inactivity worsens secondary disability. Early multi-element care including vocational/education pathways improves outcomes (RAISE-type packages; Killackey IPS in FEP). Temporary adjustments yes; automatic abandonment of roles no.[3][4]
IPS. Place-then-train supported employment: competitive jobs, rapid placement, zero exclusion based on readiness tests, integrated employment specialist, preferences, ongoing support. Meta-analysis supports roughly doubled competitive employment odds versus traditional vocational approaches.[2][4]
Family meetings. Structured family psychoeducation (not blame sessions): education, communication, problem-solving, reducing high EE — relapse prevention evidence.[7][8]
Is recovery early discharge? Name Slade uses and abuses. Genuine recovery-oriented care partners on goals (CHIME) while continuing evidence-based treatment and risk management. Recovery rhetoric must never justify under-treatment.[5][6]
Package to name. Optimised medication + family PE + IPS/supported education + cognitive remediation if needed + illness management + intensity matching engagement risk. PORT scaffolding for examiners.[1][8]
Key points
References
- [1]Dixon LB, Dickerson F, Bellack AS, et al. The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements Schizophr Bull, 2010.PMID 19955389
- [2]Modini M, Tan L, Brinchmann B, et al. Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence Br J Psychiatry, 2016.PMID 27103678
- [3]Kane JM, Robinson DG, Schooler NR, et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program Am J Psychiatry, 2016.PMID 26481174
- [4]Killackey E, Allott K, Jackson HJ, et al. Individual placement and support for vocational recovery in first-episode psychosis: randomised controlled trial Br J Psychiatry, 2019.PMID 30251616
- [5]Leamy M, Bird V, Le Boutillier C, et al. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis Br J Psychiatry, 2011.PMID 22130746
- [6]Slade M, Amering M, Farkas M, et al. Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems World Psychiatry, 2014.PMID 24497237
- [7]McFarlane WR, Dixon L, Lukens E, et al. Family psychoeducation and schizophrenia: a review of the literature J Marital Fam Ther, 2003.PMID 12728780
- [8]Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders Aust N Z J Psychiatry, 2016.PMID 27106681