PSYCHOSIS
“loss of contact with reality”
Generally includes:
- Hallucinations or perceptual distortions - usually auditory, sometimes tactile, visual, olfactory or
gustatory
- And / or delusions
- Psychosis refers to hallucinations with a non-organic cause - causes that can’t be attributed to brain
regions - e.g. dementia
Effects of hearing voices
- Causes significant distress (co-morbidity with anxiety & depression, high rates of suicide - 20%
completion rate suicide)
- Erratic behaviour (sometimes harmful to self, and very occasionally others)
- Poor concentration, distractibility (neuropsychological deficits, Rajji et al., 2009)
- ‘Social drift’ (higher prevalence in low income groups, low employment rates)
Effects of delusions
- Distress
- Elation
- Erratic behaviour
Affective psychosis: bipolar, psychotic depression
Non affective: schizophreniform disorder, Schizophrenia, schizo-affective disorder, delusional disorder.
Bentall (2003): argues for the abandonment of psychotic diagnosis altogether and advocates the alternative
approach of attempting to understand the actual beliefs and experiences of people.
PREVALENCE:
Sadler & Bebbignton (2007):
- 0.4% of the UK population
- 3.1% of black man, 0.2% white men
- Highest prevalence 35-44 age group
- 0.1% highest income, 0.9% lowest income
- Biased by peoples willingness/capacity to participate in survey?
International surveys range from 0.4% - 2%, low rates in Asian populations (Goldner et al., 2002)
No significant gender differences - men tend to have earlier onset
Onset in teens or young adulthood usually
Can have chronic recurrence or just a one off
Perula et al. (2007):
- General population survey - 8028 pps (but all in Finland)
- SCID for DSM-IV
- 3% prevalence
- Found multiple sources of information are essential for accurate estimation of lifetime prevalence of
psychotic disorders
- Prevalence in previous studies has been underreported due to methodological flaws
, Significant heterogeneity of prevalence and incidence rates - so clinicians and policy makers need to look
at local data (Goldner et al., 2002) or could be down to methodological differences in studies
Who experiences psychosis?
- Range of several psychiatric conditions, mainly SZ or bipolar, but also severe depression and some
personality disorders
- Van Os (2000)– Netherlands household survey found 17% people report psychotic phenomena, but
small proportion able to be diagnosed with a psychotic disorder.
- Is psychosis on a continuum?
KEY DEBATES:
1. Is psychosis best considered within a categorical ‘disease’ model, or as a continuum?
- People have thoughts which don’t quite feel part of them but aren’t voices, maybe further down the
continuum they would be voices
- If it’s a continuum can study normal population, if a disease can only study patients
- John & van Os (2001) 25% reported having transient delusions/hallucinations but only 3.6% met
criteria for schizophreniform illness
- Garety (2007) in a review article said the evidence supported psychosis on a continuum
- Van Os (2000) random sample of 7076b people interviewed, 17.5% of people had any type of positive
psychosis rating, only 2% had DSM-III diagnosis.
- Strauss (1969) said continuity of psychotic phenomena in clinical settings
- Van Os (2000) showed also on a continuum in the general population.
2. Can we integrate into a single theory the social, psychological and biological factors that are
implicated in the causation of psychosis?
- Side effects can be horrendous - given bad biological explanations to make them take them, we need
to integrate theories and not have them competing.
3. Untangling cause and effect in chronic illness.
- Need to study people who have not been on many drugs - large ventricles could be caused by the
illness or by medication?
THEORIES
SOCIAL (PLACE AND ETHNICITY)
Concentration of psychosis in:
- Urban groups
- The UK afro-Caribbean community
st
- 1 generation immigrants to the UK
Increases as unemployment increases
Social selection (downward drift)
Sociogenic hypothesis (more life stressors)
Social labelling (development and maintenance of symptoms are influenced by diagnosis)
“loss of contact with reality”
Generally includes:
- Hallucinations or perceptual distortions - usually auditory, sometimes tactile, visual, olfactory or
gustatory
- And / or delusions
- Psychosis refers to hallucinations with a non-organic cause - causes that can’t be attributed to brain
regions - e.g. dementia
Effects of hearing voices
- Causes significant distress (co-morbidity with anxiety & depression, high rates of suicide - 20%
completion rate suicide)
- Erratic behaviour (sometimes harmful to self, and very occasionally others)
- Poor concentration, distractibility (neuropsychological deficits, Rajji et al., 2009)
- ‘Social drift’ (higher prevalence in low income groups, low employment rates)
Effects of delusions
- Distress
- Elation
- Erratic behaviour
Affective psychosis: bipolar, psychotic depression
Non affective: schizophreniform disorder, Schizophrenia, schizo-affective disorder, delusional disorder.
Bentall (2003): argues for the abandonment of psychotic diagnosis altogether and advocates the alternative
approach of attempting to understand the actual beliefs and experiences of people.
PREVALENCE:
Sadler & Bebbignton (2007):
- 0.4% of the UK population
- 3.1% of black man, 0.2% white men
- Highest prevalence 35-44 age group
- 0.1% highest income, 0.9% lowest income
- Biased by peoples willingness/capacity to participate in survey?
International surveys range from 0.4% - 2%, low rates in Asian populations (Goldner et al., 2002)
No significant gender differences - men tend to have earlier onset
Onset in teens or young adulthood usually
Can have chronic recurrence or just a one off
Perula et al. (2007):
- General population survey - 8028 pps (but all in Finland)
- SCID for DSM-IV
- 3% prevalence
- Found multiple sources of information are essential for accurate estimation of lifetime prevalence of
psychotic disorders
- Prevalence in previous studies has been underreported due to methodological flaws
, Significant heterogeneity of prevalence and incidence rates - so clinicians and policy makers need to look
at local data (Goldner et al., 2002) or could be down to methodological differences in studies
Who experiences psychosis?
- Range of several psychiatric conditions, mainly SZ or bipolar, but also severe depression and some
personality disorders
- Van Os (2000)– Netherlands household survey found 17% people report psychotic phenomena, but
small proportion able to be diagnosed with a psychotic disorder.
- Is psychosis on a continuum?
KEY DEBATES:
1. Is psychosis best considered within a categorical ‘disease’ model, or as a continuum?
- People have thoughts which don’t quite feel part of them but aren’t voices, maybe further down the
continuum they would be voices
- If it’s a continuum can study normal population, if a disease can only study patients
- John & van Os (2001) 25% reported having transient delusions/hallucinations but only 3.6% met
criteria for schizophreniform illness
- Garety (2007) in a review article said the evidence supported psychosis on a continuum
- Van Os (2000) random sample of 7076b people interviewed, 17.5% of people had any type of positive
psychosis rating, only 2% had DSM-III diagnosis.
- Strauss (1969) said continuity of psychotic phenomena in clinical settings
- Van Os (2000) showed also on a continuum in the general population.
2. Can we integrate into a single theory the social, psychological and biological factors that are
implicated in the causation of psychosis?
- Side effects can be horrendous - given bad biological explanations to make them take them, we need
to integrate theories and not have them competing.
3. Untangling cause and effect in chronic illness.
- Need to study people who have not been on many drugs - large ventricles could be caused by the
illness or by medication?
THEORIES
SOCIAL (PLACE AND ETHNICITY)
Concentration of psychosis in:
- Urban groups
- The UK afro-Caribbean community
st
- 1 generation immigrants to the UK
Increases as unemployment increases
Social selection (downward drift)
Sociogenic hypothesis (more life stressors)
Social labelling (development and maintenance of symptoms are influenced by diagnosis)
