Psychosis

Question 1

Psychosis

Answer 1

A condition in which people have difficulty distinguishing what is real and not real

-Delusions
-Hallucinations

Often accompanied by further symptoms, such as inappropriate behavior,
disorganized speech / thinking, dissociation, disturbed mood, and social withdrawal

Question 2

Hallucinations

Answer 2

Often associated with mental illness or neurological illness, but they can occur / be induced in healthy people, too:
* Use of hallucinogens / stimulants
* Sensory deprivation / loss
* Sleep deprivation
* Headache / migraine
* Sleep paralysis

Can distinguish between “true hallucinations” and pseudo-hallucinations (where the person is aware that what they are experiencing is not real)

Also important to distinguish from synesthesia (cross-modal activation of sensory information)
* Ex. Grapheme-color synesthesia: seeing letters /
numbers as colorful

Can occur in any sensory modality
* Visual hallucinations are slightly more common than other types

Incidence seems to grow less common with development (Kelleher et al., 2012):
* Childhood: 17%
* Adolescence: 7.5%
* Adulthood: 5%

Question 3

Auditory Hallucinations in General Population

Answer 3

Simple / sporadic / transient auditory hallucinations are extremely common in the general pop.
* Hearing someone say your name, “phantom ringing / vibration” of phones, etc.

More complex hallucinations are uncommon in people
without psychosis or neurological illness, but they do occur
* Kråkvik et al. (2015): 7.3% of adults (in Norway) reported AVH – 84% never required or sought professional help

Question 4

Auditory Voice Hallucinations

Answer 4

Typically one of the more characteristic and distressing symptoms of psychosis
* Negative or commanding tone / content appears to be more common than positive content

In psychosis, hallucinations are more likely to be a
true hallucination
* Misattributed as originating outside the self and given a delusional explanation (Johns et al. 2002)

Because people often hear voices outside the context of a mental health condition, and are not distressed or dysfunctional, some believe these experiences should be de-pathologized and seen as natural, if atypical
Ex. The “Hearing Voices Movement”

Question 5

Delusions

Answer 5

Delusions are beliefs which are poorly justified by evidence or reason, and persist despite evidence which strongly contradicts the belief
* Pleas by others to abandon the belief are resisted / ignored

Delusions can be monothematic (following a single theme) or polythematic (following many
themes)
* Polythematic delusions seem particularly common in schizophrenia

Question 6

Most common type of auditory voice hallucination

Answer 6

Hostile

Question 7

What type of monothematic delusion is this

“That’s not my wife, it is an impostor who looks just like her”

Answer 7

Capgras delusion

Question 8

What type of monothematic delusion is this

” I am dead”

Answer 8

Cotard delusion

Question 9

What type of monothematic delusion is this

“I am constantly being followed by people I know, but I can’t recognize them because they are always in disguise”

Answer 9

Fregoli delusion

Question 10

What type of monothematic delusion is this

“The person I see when I look in the mirror isn’t me, it is some stranger who looks like me”

Answer 10

Mirrored-self misidentification

Question 11

What type of monothematic delusion is this

“This limb isn’t mine, it is yours”

Answer 11

Somatoparaphrenia

Question 12

What type of monothematic delusion is this

“My left arm is not paralyzed”

Answer 12

Anosognosia for hemiplegia

Question 13

What type of monothematic delusion is this

“My left arm is paralyzed”

Answer 13

Hysterical paralysis

Question 14

What type of monothematic delusion is this

“Other people can control the movements of my body”

Answer 14

Alien control

Question 15

What type of monothematic delusion is this

“Person X is secretly in love with me” (Person X being some important or famous person who has never encouraged this idea)

Answer 15

De Clerambault’s delusion (erotomania)

Question 16

What type of monothematic delusion is this

“My wife is having an affair”

Answer 16

Othello syndrome (pathological jealousy)

Question 17

Schizophrenia

Answer 17

• The most prevalent condition with psychosis as a central feature

Positive symptoms: the presence of an experience/ behavior that people typically don’t show
Ex. Hallucinations, delusions, disorganized speech

Negative symptoms: the lack of an experience/behavior that people typically do show
Ex. Social withdrawal, flat affect, poverty of speech, avolition / apathy

Question 18

Psychomotor symptoms of Schizophrenia

Answer 18

• People with schizophrenia often present with catatonia (abnormal movements or immobility)
• Many possible features / subtypes: stupor, posturing, excited, etc.
  Can develop into malignant catatonia (accompanied by fever, kidney and vascular damage, pulmonary symptoms), which is life threatening

Question 19

Avolition

Answer 19

Patients with schizophrenia sometimes report that their thoughts and actions are happening out of their control

Question 20

Delusion of control / alien control

Answer 20

Some of those patients will additionally report that they are being controlled by another person or entity

Question 21

Schizophrenia and action

Answer 21

One explanation is that patients might have a sensorimotor disorder which makes them unable to predict the outcome of their movements (Frith et al., 2000)

When our movement is accompanied by such a prediction, we know the movement is “ours” – we intended it, and had a specific goal for it

If that prediction isn’t generated, the movement will feel spontaneous/ unintentional

People with schizophrenia are prone to delusion, and may therefore rationalize bizarre / false explanations for the movement

Question 22

Schizophrenia Progression

Answer 22

Tends to follow a stereotypical course
* Prodromal phase -> active phase -> residual phase

Some patients recover completely; most will experience residual symptoms and / or occasional relapses

People with schizophrenia tend to experience lifelong social difficulties, even after recovery (Solomon et al.,2021)

Since the condition arises in young adulthood, patients tend to miss out on important life milestones (education, career development, making friends / getting married, etc.)

Question 23

Comorbidities Schizophrenia

Answer 23

Buckley et al. (2008): Amongst people diagnosed with schizophrenia,
* 15% also have panic disorder
* 29% also have posttraumatic stress disorder
* 23% also have obsessive-compulsive disorder
* 50% of patients also have depression
* 47% of patients also have a history of substance abuse

Question 24

Treatment for Schizophrenia

Answer 24

• People experiencing psychosis are often hospitalized during episodes.
  This hospitalization can be full or partial (spend the day at the hospital, then go home at night)
• Assisted living:
  Some people with schizophrenia require supervision for daily living
  Can be temporary, ex. crisis homes, or halfway homes for those who are recovering
  Can also be long-term, ex. group homes / nursing homes

Question 25

Pharmaceutical Treatments

Answer 25

Many anti-psychotic medications exist, and are effective for schizophrenia, bipolar disorder, and similar conditions
* Generally act on dopamine
* Tend to act quicker / more effectively on positive symptoms than negative symptoms

First-generation anti-psychotics have a risk of inducing movement disorders (Parkinsonism, tardive dyskinesia)
* Second-generation drugs are generally prescribed as first-line treatment, but have a risk of weight gain / metabolic dysfunction

Question 26

CBT for Schizophrenia

Answer 26

• Cognitive remediation:
• Trains patients to improve their cognitive skills, ex. attention, memory, planning, and problem-solving
• Cognitive reinterpretation and acceptance:
• Trains patients to recognize and accept hallucinations for what they are, rather than creating delusional
  explanations for them
• Goal is not to eliminate the symptoms, but to understand them more clearly and accept them

Question 27

Community approaches to Schizophrenia

Answer 27

• Assertive Community Treatment: patients
  receive intensive assistance from an integrated team of carers
• Consists of continuous contact with patients; frequent home visits; “no drop-out” policies
• Schöttle et al. (2018): provided 2-3 contacts
  per week for 4 years
  -> major decrease in days of hospitalization and day-clinic use; almost no loss of contact; significant decrease in Brief Psychiatric Rating Scores

Question 28

Family psychoeducation

Answer 28

• Patients and their families are provided
  with therapy in groups

Clients provide mutual support by sharing successes and struggles, and learn ways to manage their symptoms and relationships

Question 29

Causes of Schizophrenia

Answer 29

• Genetics:
• Dozens of genetic variations have been associated with schizophrenia
• Some researchers argue that “schizophrenia” is actually multiple co-morbid
  conditions, with different symptoms caused by different clusters of genetic variations (Arnedo et al., 2015)
• Dopamine hypothesis:
• Most effective anti-psychotic medications act on dopamine
• Drugs that affect dopamine, such as amphetamines, can induce psychosis
• Misinterpretation hypothesis: people with psychosis misinterpret sensations / perceptions as anomalous, and misattribute them to external forces (Frith et al., 2000)
• Could be due to dysfunctional sensorimotor networks, which allow us to distinguish intended and unintended movements / imagery
• Dissociation hypothesis (Kilcommons & Morrison, 2005; Shevlin et al., 2007):
• Hallucinations could be a consequence of dissociation, with fragmented memories, thoughts, and emotions emerging into consciousness without intention or context
• These experiences are then misinterpreted as uncontrolled or foreign

Question 30

Psychosis and Trauma

Answer 30

• Symptoms of PTSD often have psychotic characteristics, ex. vivid flashbacks, perceived lack of control
• Significant relationship between childhood trauma and hallucinations (Shevlin et al., 2007)
• Certain types of trauma are associated with specific types of hallucinations, ex. Neglect with visual sensations, or physical abuse with tactile sensations
• More types of trauma experienced -> increased prevalence