Psychosis Flashcards
Psychosis
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
Hallucinations
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%
Auditory Hallucinations in General Population
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
Auditory Voice Hallucinations
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”
Delusions
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
Most common type of auditory voice hallucination
Hostile
What type of monothematic delusion is this
“That’s not my wife, it is an impostor who looks just like her”
Capgras delusion
What type of monothematic delusion is this
” I am dead”
Cotard delusion
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”
Fregoli delusion
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”
Mirrored-self misidentification
What type of monothematic delusion is this
“This limb isn’t mine, it is yours”
Somatoparaphrenia
What type of monothematic delusion is this
“My left arm is not paralyzed”
Anosognosia for hemiplegia
What type of monothematic delusion is this
“My left arm is paralyzed”
Hysterical paralysis
What type of monothematic delusion is this
“Other people can control the movements of my body”
Alien control
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)
De Clerambault’s delusion (erotomania)
What type of monothematic delusion is this
“My wife is having an affair”
Othello syndrome (pathological jealousy)
Schizophrenia
- 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
Psychomotor symptoms of Schizophrenia
- 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
Avolition
Patients with schizophrenia sometimes report that their thoughts and actions are happening out of their control
Delusion of control / alien control
Some of those patients will additionally report that they are being controlled by another person or entity
Schizophrenia and action
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
Schizophrenia Progression
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.)
Comorbidities Schizophrenia
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
Treatment for Schizophrenia
- 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
Pharmaceutical Treatments
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
CBT for Schizophrenia
- 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
Community approaches to Schizophrenia
- 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
Family psychoeducation
- 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
Causes of Schizophrenia
- 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
Psychosis and Trauma
- 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
