Lecture 6: Psychosis Flashcards
Define Psychosis
An episode where one is detached from reality
Can be a symptom of sleep deprivation, substance use, mental illness, and other conditions
What are signs of a psychosis?
4 in total
- Hallucinations
- Delusions
- Agitation (onrust)
- Disorganized thought and behavior
What is schitzophrenia?
A mental illness that impacts though processes, emotions and behavior
Now more often referred to as ‘psychotic spectrum disorder’
When is one diagnosed with schitzophrenia?
One must experience at least 2 of the following symptoms for 6 months, including the first three:
- Delusions
- Hallucinations
- Disorganized speech
- Catatonic behavior
- Negative symptoms
Psychosis ‘continuum’ in the general population: psychotic experiences, psychotic symptoms, psychotic disorder (%)
Psychotic experiences: 8%
Psychotic symptoms: 4%
Psychotic disorder: 3%
What leads to psychosis?
(Extraordinary) internal/ external experiences + extraordinary meaning/ explanation = psychosis
Influences by: previous experiences + context
Previous experiences form the window people use to perceive the world
What leads to psychosis?
(Extraordinary) internal/ external experiences + extraordinary meaning/ explanation = psychosis
Influences by: previous experiences + context
Previous experiences form the window people use to perceive the world
What are risk factors for the development of psychosis?
8 in total
- Genetic risk factors
- Maternal stress
- Premature birth
- Being excluded from a group
- Bullying/ aggression
- Living in a city
- Substance abuse
- Experiences of adversity during childhood/ trauma (= major risk factor)
= interaction between genes and environmental causes
What is meant by Genotype-environment interaction?
Heritability is different in low stress environments compared to high stress environments
Why is trauma such an important risk factor?
- 3 fold increased risk when a child is traumatized
- No adverse childhood event = 33% less psychosis
- People with psychosis: 30% sexually abused, 50% physically abused
- The more trauma the higher the change of developing psychosis
What is one of the most important subjects for the prevention of psychosis?
Reducing childhood trauma!
A stage of nonspecific mental distress can lead to various types of mental health disorders (e.g. insomnia can lead to anxiety syndrome, mood syndrome, or psychosis syndrome), what model reflects this?
The clinical staging model of causal circuits
What are the consequences of psychosis? Why is prevention necessary?
5 items
- Loss of functioning (friends, partner, work)
- The longer it lasts, the worse the prognosis
- Life expectancy decreases with 10 years
- Moderate results of evidence based interventions
- Mental health problems are the leading cause of disability in young people
Why is the prevention of psychosis promising? And what are possible outcomes?
7 items (in total)
Psychosis (almost always) develops gradually, so there is time to intervene!
- Maintaing social functioning (relationships, friendships, study/ work, other social roles)
- Improve QoL
- Reduction of stigmatization and traumatic experiences (psychiatric wards)
- Improve access to mental health care
- Reduce costs
- Reduce the suffering from extraordinary experiences!!
What preventive method already exists?
Early detection of people with an At Risk Mental State (ARMS)/ Ultra high risk (UHR)
Identification of people with an ARMS/ UHR
5 items + development psychosis within 3 years
- Young 14 - 35 years old
- Decline in social functioning (effects on social relations, school/ work, self care)
- Seeking help in mental health care (for other symptoms)
- Experienced psychosis like experiences/ extraordinary experiences (as assessed by PQ-16 questionnaire)
- Comprehensive Assessment of ARMS (CAAMS interview)
+/- 1/3 develop psychosis within 3 years
Clinical staging of psychosis
4 stages
- Premorbid phase
- Prodomal phase
- ARMS
- First Episode Psychosis (FEP)
Outcome of ARMS, 3 groups:
- Subclinical mild or low-frequency psychotic experiences
- Genetic risk: primary familiy member diagnosed with a psychotic disorder or schitzotypical personality disorder
- BLIPS psychosis (Brief Limited Intermittent Psychotic Symptoms) = highest change to transition into psychosis, but not very common
High genetic risk for specific syndrome called:
Copy number variant 22q11.2DS
Is early detection and intervention in people with an ARMS/ UHR effective?
Yes!
- ARMS/UHR predict psychosis (approx. 35% tend to transition into psychosis, most of which in the first year)
- CBT for ARMS/URH decreases this rate with 50%
What does the Early Detection and Intervention Team (EDIT) do? And what are the 3 possible results?
- Screen help seeking patients aged 18 - 35 (PQ-16) e.g. at PsyQ
- If cut-off score is equal to or higher than: Comprehensive Assessment of ARMS (CAARMS): EDIT
- No ARMS = no action
- ARMS = invitation for add on CBT
- Psychosis = contact with other therapist/ referral to other department
What is CBT about?
Learning to cope with extraordinary experiences
What is a key component of CBT?
- Psycho-education (normalizing, appraisal & meaning/ explanation)
E.g. imbalance of cortisol might explain why the dopamine system works differently, and why a person perceives the environment in a different way (= stress education)
Explain the dopamine hypothesis
- Dopamime ‘fiter’ of what is deemed important lowers;
- Because is this less important things get attention = increased salience
- and are experienced as sensory perception and more meaning is attributed to them (brain makes a story)
Increased salience =
- highlighting awareness
- important information is the centre of attention
- this information triggers action
- increased cognitive though processes
