Psychosis

Question 1

Psychosis

Answer 1

• A condition in which people have difficulty distinguishing what is real and not real
  → hallucinations
  → delusions
• often accompanies by other symptoms such as inappropriate behaviour, disorganized speech/thinking, dissociation, disturbed mood, and social withdrawal

Question 2

Hallucinations

Answer 2

• Often associated with mental illness or neurological illness
• can occur in healthy people too:
  → use of hallucinogens / stimulants
  → sensory deprivation / loss
  → sleep deprivation
  → headache / migraine
  → sleep paralysis
• true hallucinations and pseudo-hallucinations (person is aware that what they are experiencing is not real)
• synesthesia: cross-modal activation of sensory information

Question 3

Delusions

Answer 3

• Beliefs that are poorly justified by evidence or reason, and persist despite evidence that contradicts the belief (pleas by others to abandon the belief are resisted ignored
• can be monothematic (following a single theme) or polythematic (following many themes, common in schizophrenia)

Question 4

Schizophrenia

Answer 4

• The most prevalent condition with psychosis as a central feature
• positive symptoms: the presence of an experience/behaviour that people typically don’t show
  → ex. Hallucinations, delusions, disorganized speech
• negative symptoms: the lack of an experience/behaviour that people typically do show
  → ex. Social withdrawal, flat affect, poverty of speech, avolition/apathy
• often present with catatonia (abnormal movements or immobility)
  → malignant catatonia: accompanied by fever, kidney and vascular damage, pulmonary symptoms

Question 5

Avolition

Answer 5

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

Question 6

Delusion of control /alien control

Answer 6

Some patients with schizophrenia (avolition) will additionally report that they are being controlled by another person or entity

Question 7

Schizophrenia progression

Answer 7

• 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 (condition arises in young adulthood se patients tend to miss out on important life milestones)

Question 8

Comorbidities

Answer 8

Amongst people diagnosed with schizophrenia:
→ vast amount also have depression or a history of substance abuse
→ may be comorbid with obsessive-compulsive disorder, posttraumatic stress disorder, panic disorder

Question 9

Treatment

Answer 9

• People experiencing psychosis are often hospitalized during episodes (can be full or partial)
• assisted living:
  → some people with schizophrenia require supervision for daily living
  → can be temporary (crisis homes, halfway homes)
  → can also be long-term (group homes, nursing homes)

Question 10

Pharmaceutical treatments

Answer 10

• Many anti-psychotic medications exist and are effective for schizophrenia, bipolar disorder, and similar conditions
  → generally act on dopamine
  → tend to act quicker and more effectively on positive symptoms than negative symptoms
• first-generation anti-psychotics have a risk of inducing movement disorders (Parkinsonism, tardive dyskensia)
• second-generation drugs are generally prescribed as first-line treatment but have a risk of weight gain or metabolic dysfunction

Question 11

Cognitive-behavioural therapy for Schizophrenia

Answer 11

• Cognitive remediation: trains patients to improve their cognitive skills 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 symptoms but rather understand them more clearly and accept them)

Question 12

Community approaches

Answer 12

• 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

Question 13

Family approaches

Answer 13

• Family psychoeducation: patients and their families are provided with therapy in groups
  → provide mutual support by sharing successes and struggles, and learn ways to manage their symptoms and relationships

Question 14

Causes

Answer 14

• Genetics: dozens of genetic variations have been associated with schizophrenia
• dopamine hypothesis: most effective anti-psychotic medications act on dopamine, drugs that affect dopamine such as amphetamines can include psychosis
• misinterpretation hypothesis: people with psychosis misinterpret sensations/perceptions as anomalous and attribute them to external forces (could be due to dysfunctional sensorimotor networks which distinguish intended/unintended movements
• dissociation hypothesis: hallucinations could be a consequence of dissociation, with fragmented memories, thoughts, and emotions emerging into consciousness without intention or context