Prelim 3- Schizophrenia and Psychosis pt.2

Brief Psychotic Disorder

• one symptom for less than one month

Schizophrenia form disorder 

• 2 symptoms lasting between 1 and 6 months 

schizophrenia

• 2 symptoms lasting more than 6 months + declines in functioning

delusional disorder

• 1 or more delusions, lasting more than one month, no disorganized speech, no hallucinations or not prominent hallucinations

Schizoaffective Disorder

• full symptoms of schizophrenia + symptoms of major mood disorder

Psychosis Treatment 

• first line: antipsychotic medications 

• relative to other disorder, higher rate of inpatient hospital admission with psychosis 

• involuntary hospitalization\

• duration varies by state and each has regular legal hearing to determine i hospitalization

involuntary hospitalization

• person is deemed legally incapable of taking care of themselves and presents immediate threat of harm to self or others

hospitalization

• around 80% of young adults with schizophrenia will be hospitalized involuntary, generally in the first 2 years of onset

• often perceived by patients as traumatic and frightening and associated with avoidance of mental health support in future

Does Hospitalization Help?

• can provide short term benefits in stabilizing symptoms or accessing new or different treatments  

• minimal evidence that provides long term changes in functioning or symptoms 

• minimal evidence that is is associated with prevention of relapse

expressed emotion (ee)

• pattern of family interaction associated with high rates of relapse rehospitalization, more severe delusional thinking, and longer episodes of severe symptoms in people with schizophrenia

• risk of rehospitlalization following discharge in high EE families is more than double than that in low EE families

3 components of expressed emotion

• criticism

• hostility

• emotional overinvolvement

criticism

negative comments about person and their behavior

hostility

family members believe symptoms are within person’s control and the patient could choose to less affected

emotional overinvolvement

family members blame themselves for illness; any problems or setbacks are perceived as their fault and not due to schizophrenia itself

What fosters EE?

• relatives high in EE tend to be more conscientious, and higher locus of control, and feel more burdened and distressed in their caregiver roles

• people with schizophrenia from high EE families tended to have higher premorbid functioning 

interventions to reduce expressed emotion

• reducing expressed emotion in family members reduces relapse and symptom severity in people with schizophrenia

• intervention is conducted primarily with family members and not people with schizophrenia themselves

• focuses on education about schizophrenia, effective communication skills and problem solving

what declines as people with schizophrenia show improvement?

EE

• suggest it may not worsen symptoms, but emerge in family members as a response to their loved one’s symptoms

Is CBT a treatment for Psychosis?

• CBTp: goal is not to reduce or re-evaluate hallucinations or delusions, but to adjust their impact

• examine behavior and feelings that are linked with hallucinations and delusions

• targets negative symptoms 

• reduces distress and effects of symptoms by 20-65%, depending on study 

• improves reasoning skills, daily functioning, and beliefs about self and others 

What is the situation —> automatic thoughts —> emotional response for psychosis?

what is the relationship between client and therapist in CBTp

• therapist avoids confronting patient about reality, gaps or contradictions in their accounts

• approach: patient’s perception of events is logical 

• normalizes cognitive processes 

• therapist conveys that a delusion is a reasonable reaction to a puzzle or threatening experience (hearing voice or panic)

• works to change response to psychotic symptoms 

Are there many CBTp therapists?

• few trained and limited availability

Hearing Voices Movement

• shift public and professional perceptions of psychosis

• challenges assumption that hearing voices are necessarily a sign of severe mental illness

• emphases that may people hear voices

• voices viewed as reflection of or reaction to life experiences, stressors, culture, relationships

• promotes empowerment and self determination by emphasizing that people should work with their voices on their own terms

Are voices a sign of mental illness?

• no, but more particularly, what the person is the person’s relationship with their voices 

• if causes distress, someone can learn how to cope with the voices and the past experiences that shape their response to the voices 

• voice cessation is not considered a sign of success or progress 

hearing voices self help groups

• user led organization present in 31 countries globally

• attendance is informal and not time-limited

• few outcome studies with small (-), but promising results

  • less distressed about hearing voices

  • gives support for hearing voices that they would not otherwise have

  • helps people make sense of hearing voices

  • greater confidence in employment and work situations, family relationships, health care system and health seeking