Psychosis literature Flashcards
waar staan we nu met dopamine hypothesis
- antipsychotic medication increase dopamine turnover, especially at dopamine D2 receptors
- the involvement of dopamine in psychosis itself is not fully proven
- post mortem studies: wel abnormalities in dopaminergic indexes in schizophrenia
- providing dopamine kan induce psychosis
the dopaminergic abnormality in schizophrenia may not be exclusive or primary, and it is likely a state abnormality rather than a fundamental abnormality. “the wind of the psychotic fire”
anhedonia hypothesis =
posits that dopamine medidates pleasure associated with rewarding experiences and neutral stimuli.
however, observations that dopamine is involved in both rewarding and aversive events, and that dopamine precedes pleasure consummation, challenges this view
incentive/motivational salience hypothesis=
dopamine converts neutral stimuli into attractive or aversive entities, theraby influencing goal directed behaviour
emphasizes the role of the mesolimbic dopamine system in attributing salience to events and thoughts, driving action and influencing decision making
psychosis is therefore a disorder of…
aberrant salience
patients typically undergo a gradual evolution of heightened awareness and emotional intensity before the onset of a full psychosis
oke
amphetamine can exacerbate symptoms in those with a history of psychosis
oke
verschil tussen delusions and hallucinations
delusions are often illogical but not impossible beliefs, arise as explanations for experiences of abberant salience, whilst hallucinations stem from the abnormal salience of internal perceptions and memories.
hoe is symptom improvement van antipsychotics
gradual and cumulative, with patients often reporting reduced distress rather than complete resolution of delusional beliefs
they reduce salience in the environment
hoe denkt aberrant salience over dopamine
dopamine dysregulation drives the neurochemical aspect, the individuals cognitive/psychodynamic and cultural context shapes the experience
hoe zou schizophrenia in relatie staan tot drug abuse
antipsychotics are associated with dysphoria, porentially stemming from their dampening effect on salience. this dampening may affect not only aberrant saliences but also normal motivations and pleasures => high incidence of drug abuse
this framework acknowledges brain-level and mind-level, without presuming etiological factors but instead pathophysiological.
oke
3 potential barriers for mutual understanding with individuals of psychosis:
- different narratives about the mental health system
- varying levels of insight and therapist theoretical perspectives
- stigmatizing beliefs held by both client and therapist
intersubjectivity=
the sharing and appreciation of subjective experiences between two individuals, forms the basis of relatedness and self-reflection in psychotherapy
what is the intersubjective proces in the context of psychotherapy
agreeing on treatment goals
- different narratives about the mental health system
the client may think of it as oppressing whilst the therapist may view it as benevolent -> leading to misunderstandings
- varying levels of insight and therapist theoretical perspectives
the client may have poor insight, deny their illness, whilst the therapist may hold theoretical perspectives on psychosis.
-> complicated shared meaning-making
- stigmatizing beliefs held by both client and therapist
therapist may adopt paternalistic attitudes, whilst the client may internalize stigma, leading to passivity and withdrawal from the therapeutic process
how can these barrieres be addressed
- metacognition
- empathy
metacognition=
awareness and integration of mental experiences, ranging from discrete perceptions to complex representations of the self and others.
empathy =
involves cognitive and emotional elements, allowing individuals to perceive and share others’ affective states
in therapy, empathy can lead to …
greater awareness and integration of experiences, fostering shared emotional states and facilitating the creation of integrated representations
therapeutic alliance is….
an intersubjective space where a unique shared narrative emerges and where coherence is prioritized over accuracy!!!
waar focused psychodynamic therapy op
childhood experiences and the function of psychotic symptoms
waar focused CBT op
the interpretation of these psychotic symptoms
why are talk therapies like CBT limited for people with psychosis
- limited resources
- therapist reluctance due to challenging nature of treating these clients
