L12: Distorted Reality - Psychotic Symptoms

Question 1

Psychosis

Answer 1

Disturbances in experience of reality or reality testing

Question 2

What are the positive symptoms of psychosis and explain them

Answer 2

• delusions = fixed beliefs that are not amenable to change in light of conflicting evidence
• hallucinations = perception-like experiences that occur without an external stimulus

Question 3

What are the most common kinds of delusions

Answer 3

• persecutory = someone/thing is spying on me/going to harm me
• referential = ordinary events/behavior have hidden meaning

Question 4

Give 5 examples of negative symptoms of psychosis

Answer 4

• lessened expressivity
• avolition = reduction of self-motivated goal-oriented activities
• alogia = reduction in speech-output
• anhedonia = reduced enjoyment of formerly enjoyable activities
• a-sociality = reduced interest in social activities

Question 5

Define disorganization

Answer 5

= difficulties in getting from A to B

Question 6

Give 2 examples of non-clinical symptoms

Answer 6

• insight into the illness (anosognosia); lack of awareness that one is ill is very common
• social cognition = looking different from how you feel; can’t read their emotions from the way they look

Question 7

What is the prevalence and lifetime prevalence of psychotic disorders

Answer 7

Prevalence; 0.7%
Lifetime prevalence; 0.04%

Question 8

What are 10 known risk factors of psychosis

Answer 8

• genetic factors
• sex and age
• prenatal and perinatal risk factors
• birth season
• age of father
• level of urbanization
• trauma as a child
• migration
• premorbid intelligence
• cannabis use

Question 9

Explain the abberant salience hypothesis of dopamine

Answer 9

Dopamine mediates the process of salience acquisition/expression; proposed that in psychosis there’s dysregulated dopamine transmission leading to stimulus-independent release of dopamine —> leads to abberant salience to external objects/internal representations

Question 10

What are 3 goals of recovery

Answer 10

1. Clinical recovery; symptom reduction
2. Personal recovery; living well in spite of symptoms
3. Social/psychosocial/societal recovery; ability for role-fulfillment

Question 11

What are 5 approaches to treatment

Answer 11

1. Biological/medical approach; labeling of symptoms as psychotic and as a result of defect brain function
2. Treatment-based community care; focus on maintaining community functioning, flexible adjusting treatment as symptoms come and go
3. Societal recovery interventions; very limited attention to symptoms, focus on managing symptoms enough for real-world outcomes —> offering people work that they can do
4. Psychological (symptom-based) - CBT; quite explicit labeling of symptoms as psychotic —> reframing symptoms and challenging underlying assumptions will reduce their impact on functioning
5. Long-term, non-symptom psychotherapy; symptoms are symptoms, irrespective of their classification —> interfere with coherent mental image of oneself and the world, developing shared understanding will help

Question 12

What are 4 pros and 5 cons of the biological approach

Answer 12

Pros
1. Quick treatment/effects
2. Easy theoretical framework/evidence base
3. Possibly very large effects
4. Adherence is relatively easy

Cons
1. Side effects
2. Loss of therapeutic alliance
3. Medication independence
4. Possible medication-carousel (trying many different kinds)
5. Long-term health effects

Question 13

What are 3 pros and 5 cons of the team-based community care

Answer 13

Pros
1. Flexibly offer variety of services
2. Community-based
3. Multidisciplinary

Cons
1. Neglect as usual —> not much attention for psychosis
2. Much turnover in practices
3. Large case loads for teams
4. Team functioning impacts care
5. Not able to offer all kinds of treatment

Question 14

What are 2 pros and 4 cons of societal recovery interventions

Answer 14

Pros
1. Real-life outcomes
2. Relatively direct improvement of quality of life

Cons
1. Difficult to implement
2. Reliance on factors outside mental health care
3. Stigma
4. Effects of failing

Question 15

What are 4 pros and 3 cons of CBT

Answer 15

Pros
1. Short treatment
2. Well-researched and protocolized
3. Can be delivered by psychologists but also by nurses
4. Transferable between professionals

Cons
1. Limited success with limited number of patients
2. Not all symptoms are very amenable —> doesn’t really work for negative symptoms
3. Lack of insight (from client) = big obstacle

Question 16

What are 3 pros and 5 cons of long-term, non-symptom psychotherapy

Answer 16

Pros
1. Non-stigmatizing
2. Definitely helped some patients
3. Long-term

Cons
1. Difficult to administer/teach
2. Evidence-base fragmented/shaky
3. Complicated to validate case conceptualization
4. Barely transferable between therapists
5. (Extermely) long-term

Question 17

What are 3 possible barriers to mutual understanding in clients with psychosis

Answer 17

1. Need to overcome differences in the personal narrative of client/clinician with regard to their roles in the mental health system and the role of the mental health system itself
2. Lack of joint understanding between client/clinician about what is (not) mental health/mental illness
3. Belief that client may not be an equal party who can make meaning of their challenges —> stigma (from clinician) and self-stigma (from client)

Question 18

What are two possible paths for resolving these barriers

Answer 18

1. Metacognition = ability to think about one’s own thinking when learning
2. Empathy

Question 19

What are 3 neurocognitive theories that explain hallucinations

Answer 19

1. Errors in source monitoring —> internal information is assigned as coming from an external source
2. Perception isn’t just coming from the sense (bottom-up), but also from expectations (top-down)
3. Mental imagery does not seem to just be more perception-like, but it is possible that the top-down factors are allocated more importance by the brain

Question 20

What are 4 social risk factors

Answer 20

• growing up in an urbanized area
• minority group position
• cannabis use
• developmental trauma