Psychosis & Schizophrenia – Week 3 | Clinical Psychology
1. THE CONCEPT OF PSYCHOSIS
Psychosis: a diagnostic label used when a person has experiences that are Types of Psychotic Disorder
outside the cultural norm and typically involve one or more of the following: Disorder Key features Why it matters clinically
Hallucinations: perceptual experiences that others cannot verify, such as Schizophrenia Hallucinations, delusions, Often associated with
hearing voices or seeing things. disorganised thinking and/or long-term contact with
Delusions: strongly held beliefs that others do not share, often maintained negative symptoms. secondary mental health
despite contradictory evidence — e.g. persecutory beliefs, beliefs about services, but outcomes
special powers. vary widely.
Disordered thought/speech: difficulty organising thoughts coherently, Schizoaffective Schizophrenia symptoms plus Shows overlap between
affecting communication and concentration. disorder prominent mood disorder psychosis and mood;
Negative symptoms: reductions in expected functioning — avolition, symptoms. challenges neat diagnostic
apathy, emotional withdrawal, self-neglect. boundaries.
Positive symptoms = experiences added to the normal behavioural Bipolar disorder Psychosis occurs alongside Psychotic content often
repertoire (hallucinations, delusions, disordered speech). with psychosis mania and/or severe relates to mood state;
Negative symptoms = emotional withdrawal, apathy, lack of motivation, depression. formulation must include
mood context.
self-neglect.
Additional symptoms e.g. depression, suicidal thoughts, problems with Postpartum Psychosis following childbirth. High-risk, time-sensitive;
memory, attention and theory of mind. psychosis requires rapid specialist
care.
A generally disturbed relationship with reality. Psychosis should not be Delusional disorder Persistent delusions without Delusional beliefs can
treated as a single, simple disease entity. Psychosis is NOT automatically the broader symptom profile exist without severe
the same as schizophrenia. of schizophrenia. disorganisation or
negative symptoms.
Evaluation: this symptom grouping is useful for description, but it can make
experiences seem detached from the person's life, history and social context. Acute & transient Sudden onset of psychotic Psychosis does not
Strong answers always contextualise symptoms. psychotic disorder symptoms that resolve within always have a chronic
a shorter period. course.
, Psychosis & Schizophrenia – Week 3 | Clinical Psychology
2. EPIDEMIOLOGY, COURSE AND OUTCOME
Schizophrenia is often described as the most prevalent psychotic disorder, Suicide risk and mortality:
but prevalence estimates vary because diagnostic practice is inconsistent Outcomes can only be measured in survivors
across studies and cultures. ~40% of excess mortality in schizophrenia is due to suicide
McGrath et al. (2008): median lifetime morbid risk ≈ 7.2 per 1,000 people ~5% of people diagnosed with schizophrenia end their life by suicide (rate
(~1% of the population). Equal risk for men and women. Mortality risk 2–3× = 0.3% for the general population)
higher (median SMR = 2.7). Excess mortality equivalent for men and 20–50% of those with a schizophrenia diagnosis will attempt suicide at
women. least once in their lifetime
Following diagnosis, many patients remain on medication and live in the First Episode Psychosis is a high-risk period — suicide mortality highest
community. Outcomes are intrinsically variable (patient to patient). No in the first few years
standardised outcome measure — so reported outcomes vary (study to Recent meta-analysis: in the general population, those reporting
study). General agreement that outcomes can be expressed as either psychotic experiences show elevated suicide risk compared with those
symptom remission or social functioning. who do not
Complex entanglement of factors contributing to suicide risk
Annualised outcomes (Huxley et al., 2021):
Following… Symptom remission Social recovery Outcome area Exam-useful point Evaluation
First episode* 57.14% (±15.4%) 47.3% (±20.7%) Symptom Many experience symptom Remission is not the same
remission reduction after first episode as full recovery or quality of
Multiple episodes* 37.75% (±14.9%) 43.5% (±23.0%) psychosis, but rates decrease life.
*No significant gender differences. Huxley et al (2021) — supports early with multiple episodes.
intervention window. Social recovery Includes employment, Psychosocial supports may
relationships, education, be as important as symptom-
Course and outcome statistics are useful, but they can obscure individual
independence and focused treatment.
variability. Outcomes may differ between early and multiple episodes; first
community participation.
episode psychosis is a particularly important intervention window because
risk of relapse, suicide and social deterioration can be highest early on. Suicide risk Elevated suicidal behaviour; Risk is not caused by
risk highest in first episode. diagnosis alone;
hopelessness, stigma,
depression, trauma all
contribute.
Mortality Excess mortality includes A purely symptom-based
suicide and physical health model underestimates
inequalities. physical and social needs.
1. THE CONCEPT OF PSYCHOSIS
Psychosis: a diagnostic label used when a person has experiences that are Types of Psychotic Disorder
outside the cultural norm and typically involve one or more of the following: Disorder Key features Why it matters clinically
Hallucinations: perceptual experiences that others cannot verify, such as Schizophrenia Hallucinations, delusions, Often associated with
hearing voices or seeing things. disorganised thinking and/or long-term contact with
Delusions: strongly held beliefs that others do not share, often maintained negative symptoms. secondary mental health
despite contradictory evidence — e.g. persecutory beliefs, beliefs about services, but outcomes
special powers. vary widely.
Disordered thought/speech: difficulty organising thoughts coherently, Schizoaffective Schizophrenia symptoms plus Shows overlap between
affecting communication and concentration. disorder prominent mood disorder psychosis and mood;
Negative symptoms: reductions in expected functioning — avolition, symptoms. challenges neat diagnostic
apathy, emotional withdrawal, self-neglect. boundaries.
Positive symptoms = experiences added to the normal behavioural Bipolar disorder Psychosis occurs alongside Psychotic content often
repertoire (hallucinations, delusions, disordered speech). with psychosis mania and/or severe relates to mood state;
Negative symptoms = emotional withdrawal, apathy, lack of motivation, depression. formulation must include
mood context.
self-neglect.
Additional symptoms e.g. depression, suicidal thoughts, problems with Postpartum Psychosis following childbirth. High-risk, time-sensitive;
memory, attention and theory of mind. psychosis requires rapid specialist
care.
A generally disturbed relationship with reality. Psychosis should not be Delusional disorder Persistent delusions without Delusional beliefs can
treated as a single, simple disease entity. Psychosis is NOT automatically the broader symptom profile exist without severe
the same as schizophrenia. of schizophrenia. disorganisation or
negative symptoms.
Evaluation: this symptom grouping is useful for description, but it can make
experiences seem detached from the person's life, history and social context. Acute & transient Sudden onset of psychotic Psychosis does not
Strong answers always contextualise symptoms. psychotic disorder symptoms that resolve within always have a chronic
a shorter period. course.
, Psychosis & Schizophrenia – Week 3 | Clinical Psychology
2. EPIDEMIOLOGY, COURSE AND OUTCOME
Schizophrenia is often described as the most prevalent psychotic disorder, Suicide risk and mortality:
but prevalence estimates vary because diagnostic practice is inconsistent Outcomes can only be measured in survivors
across studies and cultures. ~40% of excess mortality in schizophrenia is due to suicide
McGrath et al. (2008): median lifetime morbid risk ≈ 7.2 per 1,000 people ~5% of people diagnosed with schizophrenia end their life by suicide (rate
(~1% of the population). Equal risk for men and women. Mortality risk 2–3× = 0.3% for the general population)
higher (median SMR = 2.7). Excess mortality equivalent for men and 20–50% of those with a schizophrenia diagnosis will attempt suicide at
women. least once in their lifetime
Following diagnosis, many patients remain on medication and live in the First Episode Psychosis is a high-risk period — suicide mortality highest
community. Outcomes are intrinsically variable (patient to patient). No in the first few years
standardised outcome measure — so reported outcomes vary (study to Recent meta-analysis: in the general population, those reporting
study). General agreement that outcomes can be expressed as either psychotic experiences show elevated suicide risk compared with those
symptom remission or social functioning. who do not
Complex entanglement of factors contributing to suicide risk
Annualised outcomes (Huxley et al., 2021):
Following… Symptom remission Social recovery Outcome area Exam-useful point Evaluation
First episode* 57.14% (±15.4%) 47.3% (±20.7%) Symptom Many experience symptom Remission is not the same
remission reduction after first episode as full recovery or quality of
Multiple episodes* 37.75% (±14.9%) 43.5% (±23.0%) psychosis, but rates decrease life.
*No significant gender differences. Huxley et al (2021) — supports early with multiple episodes.
intervention window. Social recovery Includes employment, Psychosocial supports may
relationships, education, be as important as symptom-
Course and outcome statistics are useful, but they can obscure individual
independence and focused treatment.
variability. Outcomes may differ between early and multiple episodes; first
community participation.
episode psychosis is a particularly important intervention window because
risk of relapse, suicide and social deterioration can be highest early on. Suicide risk Elevated suicidal behaviour; Risk is not caused by
risk highest in first episode. diagnosis alone;
hopelessness, stigma,
depression, trauma all
contribute.
Mortality Excess mortality includes A purely symptom-based
suicide and physical health model underestimates
inequalities. physical and social needs.
