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Prevention of Mental Health Problems > Lecture 6: Psychosis > Flashcards

Lecture 6: Psychosis Flashcards

1
Q

Define Psychosis

A

An episode where one is detached from reality

Can be a symptom of sleep deprivation, substance use, mental illness, and other conditions

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2
Q

What are signs of a psychosis?

4 in total

A
  1. Hallucinations
  2. Delusions
  3. Agitation (onrust)
  4. Disorganized thought and behavior
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3
Q

What is schitzophrenia?

A

A mental illness that impacts though processes, emotions and behavior

Now more often referred to as ‘psychotic spectrum disorder’

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4
Q

When is one diagnosed with schitzophrenia?

A

One must experience at least 2 of the following symptoms for 6 months, including the first three:

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Catatonic behavior
  5. Negative symptoms
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5
Q

Psychosis ‘continuum’ in the general population: psychotic experiences, psychotic symptoms, psychotic disorder (%)

A

Psychotic experiences: 8%
Psychotic symptoms: 4%
Psychotic disorder: 3%

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6
Q

What leads to psychosis?

A

(Extraordinary) internal/ external experiences + extraordinary meaning/ explanation = psychosis

Influences by: previous experiences + context

Previous experiences form the window people use to perceive the world

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6
Q

What leads to psychosis?

A

(Extraordinary) internal/ external experiences + extraordinary meaning/ explanation = psychosis

Influences by: previous experiences + context

Previous experiences form the window people use to perceive the world

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7
Q

What are risk factors for the development of psychosis?

8 in total

A
  1. Genetic risk factors
  2. Maternal stress
  3. Premature birth
  4. Being excluded from a group
  5. Bullying/ aggression
  6. Living in a city
  7. Substance abuse
  8. Experiences of adversity during childhood/ trauma (= major risk factor)

= interaction between genes and environmental causes

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8
Q

What is meant by Genotype-environment interaction?

A

Heritability is different in low stress environments compared to high stress environments

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9
Q

Why is trauma such an important risk factor?

A
  • 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
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10
Q

What is one of the most important subjects for the prevention of psychosis?

A

Reducing childhood trauma!

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11
Q

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?

A

The clinical staging model of causal circuits

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12
Q

What are the consequences of psychosis? Why is prevention necessary?

5 items

A
  • 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
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13
Q

Why is the prevention of psychosis promising? And what are possible outcomes?

7 items (in total)

A

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!!
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14
Q

What preventive method already exists?

A

Early detection of people with an At Risk Mental State (ARMS)/ Ultra high risk (UHR)

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15
Q

Identification of people with an ARMS/ UHR

5 items + development psychosis within 3 years

A
  1. Young 14 - 35 years old
  2. Decline in social functioning (effects on social relations, school/ work, self care)
  3. Seeking help in mental health care (for other symptoms)
  4. Experienced psychosis like experiences/ extraordinary experiences (as assessed by PQ-16 questionnaire)
  5. Comprehensive Assessment of ARMS (CAAMS interview)

+/- 1/3 develop psychosis within 3 years

16
Q

Clinical staging of psychosis

4 stages

A
  1. Premorbid phase
  2. Prodomal phase
  3. ARMS
  4. First Episode Psychosis (FEP)
17
Q

Outcome of ARMS, 3 groups:

A
  1. Subclinical mild or low-frequency psychotic experiences
  2. Genetic risk: primary familiy member diagnosed with a psychotic disorder or schitzotypical personality disorder
  3. BLIPS psychosis (Brief Limited Intermittent Psychotic Symptoms) = highest change to transition into psychosis, but not very common
18
Q

High genetic risk for specific syndrome called:

A

Copy number variant 22q11.2DS

19
Q

Is early detection and intervention in people with an ARMS/ UHR effective?

A

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%
20
Q

What does the Early Detection and Intervention Team (EDIT) do? And what are the 3 possible results?

A
  • 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
  1. No ARMS = no action
  2. ARMS = invitation for add on CBT
  3. Psychosis = contact with other therapist/ referral to other department
21
Q

What is CBT about?

A

Learning to cope with extraordinary experiences

22
Q

What is a key component of CBT?

A
  • 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)

23
Q

Explain the dopamine hypothesis

A
  • 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

24
Q

What practical advice is given to people who experience psychosis/ psychotic symptoms?

7 items

A
  • Reduce drug use, as it affects the dopamine system
  • Talk to loved ones/ confidants about the experience
  • Maintain social activity
  • Maintain a good sleep pattern and healthy lifestyle
  • Try not to worry
  • Don’t get involved with things that scare you
  • Decrease stress/ effect of trauma (treatment)

Prevention of Mental Health Problems (8 decks)

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