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psych310 > Lecture 19: Psychosis > Flashcards

Lecture 19: Psychosis Flashcards

1
Q

Psychosis

A
  • A serious mental illness characterised by defective or lost contact with reality often with hallucinations or delusions
  • A neurological disorder, believed to be caused by a biochemical imbalance in brain (schizophrenia)
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2
Q

DSM5

A
  • Schizophrenia spectrum & other psychotic disorders = they are defined by abnormalities in one or more of the following 5 domains -> delusions, hallucinations, disorganised thinking, disorganised motor behaviour, & negative symptoms
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3
Q

British Psychological Study Definition

A
  • Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse etc.
  • Calling them symptoms of mental illness, psychosis…is only one way of thinking about them, with positives & negatives
  • The problems we think of as ‘psychosis’ can be understood & treated in same way as other psychological problems
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4
Q

What is psychosis (NZEIPS)?

A
  • Range of unusual experiences that a person may have
  • Can affect how a person thinks, feels & experiences world
  • Result in directly telling what is real from not & can be distressing
  • Potential to disrupt person’s ability to maintain life responsibilities
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5
Q

Symptoms vs. Disorder

A
  • Symptoms present in general pop. = 13.2-17.5%
  • Psychotic ‘disorder’ related to severity = distress & impairment in functioning
  • Spectrum, on a continuum
  • Romme & Escher = voices not a sign of illness
    = reaction to life events
    = many voice hearers do not have mental illness & function well
    = people seek help due to overwhelming distress
    = voices have meaning relevant to experiences of voice hearer
  • Psychosis is not a diagnosis, but symptoms can be a feature of PTSD, schizo etc…
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6
Q

Schizophrenia

A
  • Syndrome rather than disease
  • Psychosis present for at least 6/12mnths
  • Issues with validity & reliability
  • Stigma & clinical pessimism
  • Heterogenous disorder with variety of causes & outcomes
  • Still poorly understood
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7
Q

Phenomenology (+ve)

A

Positive symptoms = those that psychosis adds

  1. Delusions = false beliefs that persist in spite of evidence to contrary
  2. Hallucinations = experiencing things that others are not experiencing
  3. Thought insertion = person experiences thoughts are put into mind by external source
  4. Thought withdrawal = person experiences thoughts being removed by external source
  5. Thought broadcast = experiences thoughts as being spoken aloud or heard by others
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8
Q

Phenomenology (-ve)

A

Negative symptoms = those which psychosis inhibits

  1. Avolition & loss of drive = content with doing little
  2. Poverty of thought control = minimal conversation, generativity
  3. Thought disorder = difficulty concentrating
  4. Asociality = isolative, lack of reciprocity
  5. Flattened emotional experience
  6. Harder to work with
  7. Overlap with depression, medication effects…
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9
Q

Hallucinations

A
  • Auditory = voices most common & distressing
    = feel real, heard in external space
    = different forms -> commentating, ancestors, pleasant supportive
  • Visual = more associated with drugs, trauma…
  • Other modalities = tactile, olfactory…
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10
Q

Delusions

A
  • Fixed false beliefs = that persist in spite of evidence to contrary
  • Common themes e.g. paranoia, religiose, kapgras…
  • Influenced by culture
  • Can include beliefs about other psychotic experiences = voice is the devil’s etc.
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11
Q

Experience of psychosis

A
  • Varies from person to person and over time
  • Often confusing
  • May not be aware that their experiences are not objectively shared by other
  • Distressing
  • Debilitating
  • Lonely (feeling cut off)
  • Despair & loss of hope
  • Stigmatising
  • Preoccupying
  • Loss of sense of self
  • treatment (+/-)
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12
Q

Can be a positive experience…

A
  • Positive if perhaps unrealistic ideas e.g. religiouse delusions
  • Comfort from voices = company, positive messages
  • Indirect info about emotions or concerns
  • Creativity
  • Entertainment (e.g. trippy experiences)
  • Posttraumatic growth
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13
Q

Risks associated with psychosis

A
  • Disability = UK: 88% unemployment rate
  • Risks of chronicity = loss of productivity, health burden
  • Other health related issues = 3x more likely to die
    = smoking (2x higher)
    = homelessness
  • Suicide = up to 10% with chronic psychosis complete suicide
    = highest risk time around 1st contact
    = around diagnosis
    = higher for men than women compared to general population
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14
Q

Stages of psychosis

A
  • Premorbid phase
  • Prodrome or At Risk Mental States (ARMS) = precedes onset
  • BLIPS & APS
  • First episode of psychosis
  • Recovery
  • Relapse
  • Further recovery etc.
  • Posttraumatic growth
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15
Q

ARMS/Procedure

A
  • Insidious and gradual changes
  • Huber’s Basic Symptoms = sensitivity to stress, flattening emotions, reduced drive
  • Attenuated Psychotic Symptoms (APS) = magical thinking, suspiciousness, illusions
  • Brief Limited Intermittent Psychotic Symptoms (BLIPS) = hearing name called
  • Drop off in functioning
  • ARMS does not always transition to psychosis
  • Often only identified in hindsight to psychosis
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16
Q

Acute phase

A
  • Often first becomes apprent to others
  • Characterised by florid symptoms
  • Marked distress, confusion
  • Often self medication increases
  • Profound impact on functioning
  • Hard to help = low recognition/insight
17
Q

Recovery

A
  • Many people make a good recovery
  • Recovery can be complicated for some
  • Many experience relapse
  • Symptom resolution vs. functional recovery
  • Psychosis is a significant life event = impact on sense of self, stigma…
18
Q

Treatment (medication)

A
  • Anti-psychotics often remain first choice
  • Most report moderate improvement
  • High variability in effects between people (trial & error)
  • Efficacy vs. tolerability, risks vs. benefits
  • Takes time to work
  • Not well tolerated by some
  • Side effects can be significant e.g. weight gain, sedation
  • High discontinuation rates
  • Sometimes given involuntarily
  • Long-term effects not well understood
  • May shorten L.E for some
  • Treatment not cure
  • ‘Dampening down’ effect not targeted treatment
19
Q

Treatment (psychological approaches)

A
  • CBT most studied and evidence for = recommended for ARMS
  • Third wave therapies
  • Most clinicians use integrated approach
  • Narrative approaches, cultural approaches
  • Hearing Voices Network, Open Dialogue
  • Focus on engagement + rapport
  • Less evidence for psychodynamics approaches
20
Q

CBT

A
  • Aims to alleviate distress
  • Change the distressing beliefs about symptoms like voices
  • Normalising approach
  • Collaborative Empiricism = client as expert of their own experiences
    = behavioural experiments
21
Q

ACT

A
  • Seeks to help people to relate different to their distressing experiences
  • Voices as life events
  • Acceptance of distress as transient & normal
  • Increased capacity to cope with distress
  • Reduced fusion with unhelpful ideas
  • Committed action informed by values rather than psychotic symptoms
  • Self-compassion
22
Q

Targets for therapy

A
  • Beliefs about experiences
  • Normalisation
  • Relating to unwanted experiences
  • Re-authoring
  • Trauma
  • Directly with voices & delusions
  • Substance use (MI)
  • Other comorbidities
23
Q

Early intervention for Psychosis

A
  • Biggest dev. in psychiatry in last 20 years
    = optimistic & client-centred approach
    = practical & pragmatic, family involvement
    = rise of psychosocial treatments, esp. psychological
    = consumer movement unhappy with institutionalisation & clinical pessimism
  • Focus on proactive engagement, risk management, secondary prevention
24
Q

Aims of Early Intervention

A
  • Improve access to early treatment
  • Reduce delays to treatment
  • Promote meaningful engagement
  • Intensive input during critical period
  • Reduce risks e.g. suicide
  • Secondary prevention
  • Promote functional recovery
  • Reduces distress & stigma
25
Q

How does EI do this?

A
  • Engagement first
  • Optimistic & normalising approach
  • Youth-friendly culture
  • Client-centred & flexible
  • Holistic & integrated MDT
  • Practical approach, ‘whatever it takes’
  • Well resourced & mobile teams
  • Psychological perspective
  • Proactive approach to referrals
26
Q

Effectiveness of EI

A
  • Suicide risk is halved
  • > 50% secure a job
  • Reduced relapse
  • Promotes more complete recovery
  • Reduced rates of admission to inpatient units
  • Better treatment of comorbidities
  • Much more user friendly
  • Cost effective = but more expensive upfront costs (staffing)
27
Q

Who gets psychosis?

A
  • First episode = young people
  • Prevalence of 3% over lifetime
  • Similar rates across cultures & countries
  • Increased rates in urban areas
  • Minority groups experience higher rates
28
Q

Causes of psychosis

A
  • Mechanisms not well understood
  • Trauma & social deprivation
  • Genetics play a role but often oversimplified
  • Often multiple factors
  • Risk & vulnerability
  • Stress & vulnerability model
29
Q

Stress & vulnerability

A
  • All people are vulnerable to psychosis
  • Psychosis can be caused by stress from life events or internal experiences
  • Some people’s vulnerabilities are lower than others
  • And some people’s stressors are higher
  • When stress outstrips coping…psychosis can happen
30
Q

Trauma & psychosis

A
  • Strong association
  • Previously denied (focus on bio-bio-bio model)
  • Content of psychotic symptoms often congruent with traumatic experience
  • People with childhood trauma are 9x more likely to experience psychosis
  • Higher rates in refugee population
  • Dose effect
  • Makes sense, psychosis as a defense
31
Q

Maori & psychosis

A
  • Different indigenous conceptualisations of experiences that we may label psychosis = common everyday experiences (common to hear voices)
    = whakapapa/tupuna
    = matakite/gift
    = maori illness
    = trauma
    = substance use (haurangi)
  • Effects of intergeneration trauma, colonisation as risk factors
32
Q

Drugs & psychosis

A
  • Many substances can cause psychotic symptoms
  • Intoxication vs. drug induced
  • Marijuana is not benign
  • THC use prior to age 15 greatest risk
  • Heavy use prior to 19 (10.3% increased risk)
  • Epigenetics: nature via nurture (genes switched on by adversity/drugs)

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