Psychosis

Psychosis

Definitions
1. Reality testing impaired, markedly interferes with capacity to meet everyday demands
2. Psychosis is a symptom, not a diagnosis
3. Schizophrenia diagnosis
  1. Hallucinations
    1. Sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ
  2. Social/occupational dysfunction
  3. 6 month duration
  4. Delusions
    1. A tenaciously held belief, which does not respond to reason and that is judged to be at odds with the individual's usual culture & environment
  5. Disorganised speech
    1. Thought form. Thought derailment
  6. Negative symptoms
    1. Lack of motivation
  7. Problems with diagnosis
    1. Reliability & validity, disagreements,
    2. Symptom-based approaches
    3. Continuum hypothesis
      1. 1/5 of normal population have experienced hallucinations & delusions
Causes
1. Stress-vulnerability Model (Zubin & Spring, 1977)
2. Genetics
  1. 89% have no relative with condition
  2. Closer bio relationship - greater risk of relative having it
3. Dopamine hypothesis
  1. Schizophrenia, amphetamine psychosis & Parkinson's disease
  2. Neuroleptics can also stop amphetamine psychosis
4. Brain structure
  1. Lateral ventricles larger
    1. Caused by psychotic experiences or drugs?
5. Trauma
  1. Diagnosed more likely to have experienced traumatic events
  2. Dose-response effect
6. Family relationships
  1. Expressed Emotions
    1. High EE - more relapse (65% vs. 35%)
  2. Walder et al. (2014)
    1. Disruptions elevated in families with first-degree relative with Sz.
    2. Polygenic neurodevelopmental diathesis-stress model
7. Societal factors
  1. Low SES = more psychosis
  2. Larger cities
  3. Social isolation theory
  4. Social drift hypothesis
Substance use
1. Positive experiences
  1. Drowns out voices, reduces anxiety
2. Cannabis
  1. THC skunk 3x increase in psychosis that non-users
  2. Use of skunk every day = higher risk of psychiatric disorders
Treatments
1. Medical
  1. Neuroleptics
    1. 2/3 relapse in 2 years
    2. Side effects
      1. Sedation
      2. Depression
      3. Extrapyramidal or Parkinson-like effects
        Akathisia - itchniness of muscles
      4. Tardice dyskinesia - fly catching
      5. Clozapine induced agrankocytosis - toxic
2. Cognitive Behavioural Therapy
  1. 0.4 effect size on target symptoms (Wykes et al., 2008)
  2. NICE recommended
  3. Assessment
    1. Patient's views, reasons, situation
    2. Self-esteem, coping strategies
    3. Psychiatric interviews
    4. Symptom measures
      1. e.g. Psychotic Symptom Rating Scales
  4. Gain control
  5. Underlying bio origin, but symptoms determined by environmental, cognitive, somatic & behavioural factors which can be modified
  6. Invervention
    1. 1. Assessment & individualised formulation of presenting problems
    2. 2. Agreement on goals for change
    3. 3. Individualised information sharing
    4. 4. Behavioural & cognitive techniques
  7. Jauhar et al. (2014)
    1. CBT has therapeutic effect on Sz symptoms in the small range.
    2. But maybe it works for some symptoms but not all?
3. Family interventions
  1. Psychoeducation
  2. Goal setting
  3. Problem solving
  4. Improving communication
  5. Cognitive reapprails
  6. Decreasing anger & guilt

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